照護一位575公克極度早產兒合併餵食困難之加護經驗

Nursing Experience of Caring for a 575 Grams Extremely Premature Infant With Feeding Difficulty

10.6142/VGHN.202303_40(1).0006

曾子庭(Tzu-Ting Tzeng)；余培筠(Pei-Yun Yu)

極度早產兒 ； 餵食困難 ； 口腔按摩 ； extremely premature infant ； feeding difficulty ； oral motor

榮總護理

40卷1期（2023 / 03 / 01）

59 - 65

繁體中文;英文

本文描述一位出生僅575公克的極度早產兒因呼吸窘迫症候群插管治療，拔管後因困難餵食，案父母擔憂病情，加上住院導致親子依附關係被剝奪，故引發筆者撰寫動機；於2020年8月14日至10月20日護理期間，筆者運用系統性身體評估，藉由觀察、實際照護與會談進行家庭評估，確立其健康問題有氣體交換障礙、低效性嬰兒哺餵型態、混亂性嬰兒行為及潛在危險性父母／嬰兒依附關係障礙；筆者用心維持病嬰呼吸道通暢及促進氧合照護措施，運用發展性照護促統合發展，藉由觀察早產兒行為及運用創新口腔按摩棒進行口腔訓練，使其順利拔除胃管，同時鼓勵父母參與照護活動及執行袋鼠護理，以提升親子依附關係，建議臨床上早產兒應於生命徵象穩定後，立即評估口腔狀況，儘早介入口腔刺激，使其盡快由口胃管轉換至全口餵食，以縮短住院時間，提升早產兒照護品質。

This article describes our nursing experiences of caring for an extremely premature infant (birth weight, 575 g) who was intubated for respiratory distress syndrome. Even after extubation, the infant had feeding difficulty. The parents were concerned about the infant's condition. Furthermore, hospitalization prevented parent-infant attachment, which is the motivation for this study. Nursing care was provided from August 14, 2020, to October 20, 2020. A systematic physical assessment and a family assessment (through observation, actual care, and interviews) were performed to identify related problems. Gas exchange disorder, inefficient feeding patterns, disorganized infant behavior, and potentially dangerous parent-infant attachment disorder were noted. Airway patency was maintained, and oxygen and developmental care were provided to promote the infant's development. In addition, patient behaviors were observed. Innovative massage sticks were used to successfully extubate the patient. The parents were encouraged to participate in care activities and provide kangaroo care to improve parent-child attachment. Clinically, premature infants' oral condition should be assessed after the stabilization of vital signs. Furthermore, oral stimulation should be performed at the earliest opportunity to facilitate the switch from orogastric tubes to oral feeding, shorten infants' hospital stay, and improve the quality of care provided to premature infants.

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