協助一位燒傷個案因脫離呼吸器失敗行氣管切開手術之護理經驗

Nursing Experience of a Burn Patient with a History of Chronic Obstructive Pulmonary Disease Struggling With Weaning From a Ventilator

10.6142/VGHN.201803_35(1).0010

劉芸廷(Yun-Ting Liu)

燒傷 ； 慢性阻塞性肺部疾病 ； 焦慮 ； 脫離呼吸器 ； burn injury ； chronic obstructive pulmonary disease ； anxiety ； weaning from ventilator

榮總護理

35卷1期（2018 / 03 / 01）

88 - 95

繁體中文

本文是以個別化的護理活動協助一位燒傷合併慢性阻塞性肺病(Chronic Obstructive Pulmonary Disease, COPD)個案脫離呼吸器的護理經驗。照護期間為2013年9月5日至11月1日，筆者在護理期間透過觀察、會談、筆談及身體評估等方式收集資料，藉Gordon十一項功能性健康型態進行評估；發現個案有「呼吸器戒斷反應功能失常/與呼吸肌無耐力有關」、「焦慮/ 與擔心缺氧及與呼吸器脫離失敗有關」、「身體活動功能障礙/與長期臥床、燒傷肢體活動減少及肌力下降有關」等健康問題。同理個案無法脫離呼吸器的身、心煎熬，設計個別化的護理活動；藉由護理過程使個案維持正向健康信念，達到生理、心理的完整照護，使個案終能順利脫離呼吸器。希望藉此經驗分享，做為照護此類個案的參考。

This article explores the nursing experience of a patient with scalding burn injuries over 20% of the total body surface area. He was unable to be weaned from a ventilator because of a history of chronic obstructive pulmonary disease and tracheotomy. The period of nursing was from September 5, 2013, to November 1, 2013. Data were collected by means of direct nursing, participant observation, and interviews. Gordon's 11 functional health patterns were used for evaluation, and the patient's health issues, such as being unable to wean from a ventilator, were found to be caused by a lack of respiratory muscle power. He also suffered from anxiety brought about by worry of insufficient oxygenation and decreased body movement and muscle power. We used various techniques revolving around listening, empathy, and acceptance to design care activities for the patient. Finally, we helped the patient to wean from the ventilator and transfer to a general ward.

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