運用口腔照護於一位反覆肺炎老年病人之護理經驗

A Nursing Experience in Applying Mouth Care to an Older Patient With Recurring Pneumonia

10.6142/VGHN.202109_38(3).0011

李采婷(Tsai-Ting Li)；簡翠薇(Tsui-Wei Chien)

肺炎老年病人 ； 口腔照護 ； 健康識能不足 ； older patient with pneumonia ； oral care ； poor health literacy

榮總護理

38卷3期（2021 / 09 / 01）

322 - 329

繁體中文

本文描述一位86歲老年病人因肺炎反覆住院的護理經驗，由於外傭照顧之健康識能不足，故引發筆者之動機。護理期間為2020年2月15日至4月8日，從住院至出院返家之護理過程，病人返家後共家訪10次及電訪7次。筆者運用病歷記錄、身體評估、觀察及訪談主要照顧者等方式收集資料，且以Gordon十一項功能性健康型態進行評估，確立病人主要的健康問題，包括：呼吸道清除功能失效、潛在危險性感染與口腔清潔不良有關和主要照顧者健康識能不足。護理期間教導主要照顧者協助病人執行有效清除呼吸道分泌物的方法，並回覆示教，以維持通暢，藉每天早晚各執行一次口腔照護及唾液腺按摩，改善病人口腔清潔狀況；設計病人照顧時程表並翻譯成印尼文，指導外傭對長期臥床之相關照顧知識及技術，協助病人出院返家後之照顧品質，預防病人因肺炎再住院。期盼透過此次護理經驗的分享，提供臨床及居家護理人員照護類似病人之參考。

This article reports the nursing experience of an 86-year-old patient who was repeatedly hospitalized due to pneumonia and was placed in the care of a foreign caregiver. The care period was from February 15 to April 08, 2020, from hospitalization to the time of discharge to their home; the care discharged included 10 home visits and 7 telephone visits. The author used medical records, physical assessments, observations, and primary caregiver interviews to collect data. Gordon's 11 functional health patterns assessment was applied to assess the patient's health problems, including ineffective airway clearance, high-risk of infection due to poor oral hygiene, and poor health literacy in the caregiver. During the nursing period, the foreign caregiver was taught to assist in the case by removing respiratory secretions to maintain patency and by performing oral care and salivary gland massage twice a day (in the morning and evening) to improve the patient's oral status and reduce the incidence of pneumonia. We further taught the caregiver nursing skills for patients who were bedridden for the long term, and we designed individualized Indonesian translations of care schedules for foreign caregivers to facilitate the implementation of continual care, amelioration of health problems, and successful reduce the number of days of hospitalization. This article hopes to serve as a reference for clinical and home nurses caring for such patients.

1. 李蕙瓊,賀湘君,車慧蓮(2015)。長期照護機構外籍看護工適應歷程之前驅性研究。長期照護雜誌，19(1)，41-58。
   連結：
2. 林倩如,張宇辰,鄒孟婷,詹欣隆,陳盈如,黃麗卿(2019)。超高齡居家照護病人因肺炎住院的危險因子。台灣家庭醫學雜誌，29(1)，34-42。
   連結：
3. 黃純德(2017)。全身衰弱症高齡者的失落的一環：口腔照護。長期照護雜誌，21(3)，191-201。
   連結：
4. 蔡宜燕,劉彥君,李佳琳,楊月穎,邱逸榛(2015)。口腔健康評估量表—非牙醫專業人員中文版發展與信效度檢定。長庚護理，26(4)，400-409。
   連結：
5. Chen, H. S.(2017).Evaluation of nursing effect of comprehensive nursing intervention on elderly patients with severe pneumonia.Journal of Clinical and Nursing Research,1(2),34-39.
6. Hollaar, V. R.Y.,van der Putten, G. J.,van der Maarel-Wierink, C. D.,Bronkhorst, E. M.,de Swart, B. J. M.,Creugers, N. H. J.(2017).The effect of a daily application of a 0.05% chlorhexidine oral rinse solution on the incidence of aspiration pneumonia in nursing home residents: A multicenter study.BioMed Central Geriatrics,17(1),128.
7. Huang, S. T.,Chiou, C. C.,Liu, H. Y.(2017).Risk factors of aspiration pneumonia related to improper oral hygiene behavior in community dysphagia persons with nasogastric tube feeding.Journal of Dental Sciences,12(4),375-381.
8. Ju, L. Y.,Weng, S. C.,Chung, Y. J.,Yang, S. H.,Huang, Y. H.,Huang, L. G.,Chin, C. S.,Hoogland, A. I.,Chang, P. H.(2019).Effects of the bass brushing method on dental plaque and pneumonia in older adults hospitalized with pneumonia after discharge: A randomized controlled trial.Applied Nursing Research,46,1-7.
9. Maeda, K.,Akagi, J.(2014).Oral care may reduce pneumonia in the tube-fed elderly: A preliminary study.Dysphagia,29(5),616- 621.
10. 王牧羣,楊鎮嘉,黎家銘(2017)。老人社區型肺炎之預防。台灣老年醫學暨老年學雜誌，12(1)，20-28。
11. 台灣感染症醫學會（2019，3 月 15 日）．台灣肺炎診治指引（2018 年中文版）．https://www.idsroc.org.tw/DB/health/24.pdf?v=202156172525
12. 許瀞文,李璧伊,湯振青,陳思豪(2018)。談出院準備服務。家庭醫學與基層醫療，33(10)，285-289。
13. 衛生福利部統計處（2020，6 月 16 日）．108年死因統計結果分析．https://dep.mohw.gov.tw/DOS/lp-4927-113.html
14. 衛生福利部統計處（2018，9 月）．中華民國106 年老人狀況調查報告．https://www.mohw.gov.tw/dl-48636-de32ad67-19c8-46d6-b96c-8826f6039fcb.html