一位雙側聲帶麻痺行氣管切開術後嬰兒及其家庭護理經驗

Nursing Experience of a Baby and his Family with Bilateral Vocal Cord Paralysis Undergoing Tracheotomy

兒科護理強調以家庭為中心，同時重視病人與家屬需求。本文為照顧一位雙側聲帶麻痺行氣管切開術後嬰兒及其家庭護理經驗。護理期間為2019年11月28日至12月14日，筆者依生理、心理、社會及靈性四個層面對個案與家屬進行評估，護理問題包括：急性疼痛、呼吸道清除功能失效、照顧者角色緊張、家庭運作過程改變。急性疼痛問題：以嬰兒行為疼痛評估量表評估、採集中護理、止痛藥物及非藥性減緩疼痛措施，如安撫奶嘴、寧握護理等，以減少疼痛；呼吸道清除功能失效問題：監測生命徵象、調整呼吸器與加溫器使用以增加氣體交換功能及排除痰液以促進呼吸道順暢；照顧者角色緊張問題：運用同理技巧建立關係、個別教導、提供彈性探訪時間、採漸進式教學並回覆示教，提升照護能力與信心；家庭運作過程改變問題：評估家庭成員角色功能及經濟情形，透過與家庭成員共同討論及計畫完成出院準備，緩解主要照顧者負擔。藉此護理經驗，提醒護理人員重視嬰兒與家屬之整體照護，建議護理人員強化護理指導，設計兼具療癒氣氛、安靜及舒適的隱密環境，鼓勵家屬表達感受、學習照顧技巧並執行出院計畫及居家護理追蹤，達到持續性與整體性的照護。

Pediatric nursing emphasizes familycentered, and at the same time pays attention to the needs of patients and family members. This article is about caring for a baby with bilateral vocal cord paralysis after tracheotomy and his family nursing experience. The nursing period is from November 28 to December 14, 2019. The author assesses the case and family members on four levels: physical, psychological, social, and spiritual. Nursing problems include: acute pain, respiratory tract clearance failure, and the role of caregiver Tension, changes in the process of family operations. Acute pain: use the Neonatal Infant Pain Scale to evaluate, collect nursing, analgesics, and non-medicinal pain relief measures, such as pacifiers, holding nursing, etc., to reduce pain; airway clearance function Failure problem: monitor vital signs, adjust the use of respirators and warmers to increase gas exchange function and eliminate sputum to promote smooth airway; the role of caregivers is tense: use empathy skills to establish relationships, teach individually, provide flexible visit time, Adopting progressive teaching and replying to teaching to improve care ability and confidence; family operation process change issues: assess family members' role functions and economic situation, and complete preparations for discharge through discussions and plans with family members to ease the burden of main caregivers. Take this nursing experience to remind nursing staff to pay attention to the overall care of babies and family members. It is recommended that nursing staff strengthen nursing guidance, design a quiet and comfortable private environment with a healing atmosphere, encourage family members to express their feelings, learn care skills, and implement discharge plans. Painting and home care tracking to achieve continuous and holistic care.