一位肺炎併急性呼吸衰竭病人行氣切造口術之護理

Nursing Care of a Patient with Pneumonia and Acute Respiratory Failure Undergoing Tracheostomy

本文為照顧一位肺炎併急性呼吸衰竭行氣切造口術之病人，因首次面對氣切造口留置感到緊張和不安，擔心家屬無法照顧與理解自己想法，而衍生焦慮之護理經驗。照護期間以病人為中心，透過會談、觀察、傾聽、陪伴等方法收集病人生、心、靈等各方面健康資料，運用Gordon 11項功能健康型態進行評估，發現病人有呼吸道清除失效、言詞溝通障礙、知識缺失及焦慮等健康問題，並依照健康問題提供個別性及整體性護理措施。藉由良好疾病照護、運用拍痰、姿位引流及胸腔物理治療使病人痰液順利排出。針對言詞溝通障礙，透過製作生理需求與日常生活圖卡、運用非語言、肢體手勢及紙筆等方式，解決病人溝通障礙挫折感。評估病人返家照護需求，介入出院準備服務，提供設備租借資訊，運用圖文衛教單張及網路相關照護影片，教導照顧者氣切及抽痰相關照護技巧，並進行討論及回覆示教，提升返家時照護品質，緩解病人及照顧者知識缺失之問題。運用引導方式鼓勵病人表達內心感受，適時給予關懷與支持，緩解病人不安與焦慮情形。希冀能藉此護理經驗，提供日後臨床護理人員之照護指引參考，提升此類病人之照護品質。

This paper describes the nursing experience of caring for a patient with pneumonia and acute respiratory failure who underwent a tracheostomy. Facing a tracheostomy for the first time, the patient felt nervous and uneasy, worrying that family members might not be able to care for them or understand their needs, which led to anxiety. A patient-centered care approach was adopted, in which the patient’s physical, psychological, and spiritual health status was comprehensively assessed through interviews, observation, and supportive presence. Using Gordon’s 11 Functional Health Patterns, several health issues were identified, including ineffective respiratory tract clearance, impaired verbal communication, knowledge deficit, and anxiety. Individualized and holistic nursing interventions were provided to address these concerns. Effective disease-management strategies, such as chest percussion, postural drainage, and thoracic cavity physiotherapy, helped promote sputum clearance. To address the communication difficulties, visual aids for basic needs and daily activities were created, and non-verbal strategies, including gestures and writing, were used to ease the patient’s frustration. The patient’s home care needs were evaluated, and discharge preparation services were provided. Caregivers received information on equipment rental, illustrated educational materials, and access to online videos on tracheostomy and suction care. Discussions and teach-back sessions were conducted to strengthen care skills and reduce knowledge gaps for both patient and caregivers. The patient was encouraged to express their feelings through guided conversations, and timely support was offered to reduce anxiety and unease. This nursing experience aims to provide a reference for clinical nursing practice and enhance the quality of care for patients with similar conditions.