一位心臟移植後反覆肺炎病人之加護經驗

Experience of Nursing a Patient with Recurrent Pneumonia After a Heart Transplant in the ICU

10.6142/VGHN.202106_38(2).0012

蘇淳婷(Chun-Ting Su)；楊易宏(Yi-Hung Yang)；鐘貴春(Kwei-Chun Chung)

心臟移植 ； 肺炎 ； 高流量鼻導管 ； 無力感 ； heart transplant ； pneumonia ； high-flow nasal cannula ； powerlessness

榮總護理

38卷2期（2021 / 06 / 01）

212 - 219

繁體中文

心臟移植後的病人需使用免疫抑制劑以避免排斥，常因免疫力不全導致肺炎反覆入院，而經歷失落、擔心與挫折等不同程度的無力感。本案例為因反覆肺炎合併血氧過低轉入加護病房，接受非侵入性的高流量鼻導管氧氣治療及肺部復健，又因面臨生命威脅的心理壓力發生無力感的心理問題，進而引發筆者動機。護理期間為2019年12月21日至26日，筆者藉由直接照護、面談、病歷查閱及運用Gordon十一項健康功能評估等方式，發現病人有氣體交換障礙、高危險性感染與無力感等三個健康問題。經醫療團隊討論後給予高流量鼻導管氧氣治療，使病人免去配戴雙向正壓呼吸器及氣管內管置入的不適，也改善了低血氧的問題，期間更加強病人心臟移植術後自我照護的能力，預防再次感染，並依病人的喜好及需求，鼓勵病人表達心理感受增強自信心。此照護經驗的分享，提供臨床護理人員照顧心臟移植後肺炎病人之參考。

Immunosuppressive agents are used after heart transplantation to avoid rejection, which could cause infection and lead to patients being repeatedly admitted to the hospital. Pneumonia is the most common of these postsurgical infections. Due to repeated admission to the hospital, patients are confronted with loss, worry, frustration, and powerlessness to varying degrees. This patient was transferred to the intensive care unit due to recurrent pneumonia and hypoxemia, and the patient received high-flow nasal cannula therapy and pulmonary rehabilitation. However, the patient had incurred psychological distress due to a sense of powerlessness caused by facing a life-threatening condition, and this distress motivated the author to report this case. The nursing period was from December 21 to 26, 2019. Through personal medical data collection, interview records, and medical record review, Gordon's 11 functional health patterns assessment revealed that the patient's problems were dysfunctional air exchange, high risk for infection, and a feeling of powerlessness. After the matter was discussed with the medical team, the patient's treatment was adjusted to high-flow nasal cannula therapy, the discomfort of bi-level positive airway pressure and endotracheal tube was avoided, and the hypoxemia was improved. We taught the patient cognitive and self-care skills after heart transplantation to prevent secondary infection, and, in accordance with the individual's preferences and needs, we encouraged him to express his feelings and enhance his self-confidence. This care experience can help nurses manage the treatment and care of patients with recurrent pneumonia after heart transplantation.

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