一位急性呼吸窘迫症候群病人與家屬面對疾病衝擊之加護經驗

Nursing Experience of Caring for Patients With Acute Respiratory Distress Syndrome and Their Families

10.6142/VGHN.202303_40(1).0010

吳美玉(Mei-Yu Wu)；金淑儀(Shu-I Chin)；連如玉(Ru-Yu Lien)

急性呼吸窘迫症候群 ； 體外膜氧合維生系統 ； 焦慮 ； 照顧者角色緊張 ； acute respiratory distress syndrome ； extracorporeal membrane oxygenation ； anxiety ； caregiver role strain

榮總護理

40卷1期（2023 / 03 / 01）

89 - 95

繁體中文;英文

本文描述一位47歲男性，因非典型肺炎併發急性呼吸窘迫症候群，緊急放置氣管內管使用呼吸器合併體外膜氧合維生系統入住加護病房的照護經驗，護理期間自2019年3月12日至29日，透過直接照護、身體評估、會談及觀察等方式進行資料收集，運用Gordon十一項健康功能型態進行整體評估，確立氣體交換障礙、焦慮及照顧者角色緊張等健康問題。照護期間筆者運用專業知識及技巧，凝聚醫療團隊通力合作以穩定其生命徵象，建立完善的呼吸照護計畫及維持肺部正常的氣體交換，面對病人焦慮不安，以同理心陪伴並了解感受與需求，早期介入復健治療，使四肢肌肉力量逐漸改善，緩解病人焦慮；針對照顧者因病人病危及照護複雜度高，主動關懷家屬予心理支持，彈性會客、傾聽個別需求，提供疾病相關資源的運用，亦讓家屬對後續照護獲得信心，勇敢面對後續照護之路，期望藉由本文照護經驗，提供護理人員未來照顧此類病人的實務參考。

This article describes our nursing experience of caring for a 47-year-old man from March 12 to 29, 2019, who was admitted to our intensive care unit because of atypical pneumonia complicated by acute respiratory distress syndrome. The patient was supported using an endotracheal tube, a ventilator, and an extracorporeal membrane oxygenation system. Data were collected through direct care, physical assessment, interviews, observation, and Gordon's 11 functional health patterns guide and were used to identify various problems, including gas exchange disorder, anxiety, and caregiver stress. Through their professional knowledge and skills, the medical team worked together to stabilize his vital signs, devise an effective respiratory care plan, ensure the maintenance of normal gas exchange in his lungs, address his anxiety, accompany him with empathy, and acknowledge his feelings. Early rehabilitation therapy may gradually improve limb muscle strength and alleviate patient anxiety. Patients with major illness require complex care; their nursing caregivers assume the responsibility of caring for them, providing psychological support to them and their family members, being available to them, acknowledging their needs, and providing disease-related services. This enables the family members to gain confidence in providing follow-up care to the patients. Our experience may serve as a practical reference for nursing staff caring for patients with acute respiratory distress syndrome.

1. Abrams, D.,Schmidt, M.,Pham, T.,Beitler, J. R.,Fan, E.,Goligher, E. C.,McNamee, J. J.,Patroniti, N.,Wilcox, M. E.,Combes, A.,Ferguson, N. D.,McAuley, D. F.,Pesenti, A.,Quintel, M.,Fraser, J.,Hodgson, C. L.,Hough, C. L.,Mercat, A.,Mueller, T.,Brodie, D.(2020).Mechanical ventilation for acute respiratory distress syndrome during extracorporeal life support. Research and Practice.American Journal of Respiratory and Critical Care Medicine,201(5),514-525.
2. Alessandri, F.,Pugliese, F.,Ranieri, V. M.(2018).The role of rescue therapies in the treatment of severe ARDS.Respiratory Care,63(1),92-101.
3. Johnson, C. C.,Suchyta, M. R.,Darowski, E. S.,Collar, E. M.,Kiehl, A. L.,Van, J.,Jackson, J. C.,Hopkins, R. O.(2019).Psychological sequelae in family caregivers of critically-III intensive care unit patients: A systematic review.Annals of the American Thoracic Society,16(7),894-909.
4. Ko, B. (2017，9 月 1 日 )．臺北榮民總醫院胸腔重症加護病房脫離呼吸器之評估及流程。https://reurl.cc/kZLXln
5. Naddour, M.,Kalani, M.,Ashraf, O.,Patel, K.,Bajwa, O.,Cheema, T.(2019).Extracorporeal membrane oxygenation in ARDS.Critical Care Nursing Quarterly,42(4),400-410.
6. Oliveira, H. S. B.,Fumis, R. R. L.(2018).Sex and spouse conditions influence symptoms of anxiety, depression, and posttraumatic stress disorder in both patients admitted to intensive care units and their spouses.Revista Brasileira de Terapia Intensiva,30(1),35-41.
7. Su, J. Y.,Lockwood, C.,Tsou, Y. C.,Mu, P. F.,Liao, S. C.,Chen, W. C.(2019).Implementing the richmond agitation-sedation scale in a respiratory critical care unit: A best practice implementation project.JBI Database of Systematic Reviews and Implementation Reports,17(8),1717-1726.
8. 王桂芸,陳麗津,洪世欣(2019)。呼吸系統疾病與護理。新編內外科護理學
9. 張于娟,陳玉如(2017)。以護理人員為主導的實證照護措施於呼吸器脫離之運用。台灣醫學，21(2)，208-217。
10. 許健威,陳垚生(2017)。預防呼吸器相關性肺炎組合式照護。內科學誌，28(1)，18-23。
11. 歐嘉美,林春只,尚忠菁,陳蓓蒂,周幸生(2019)。心臟血管系統疾病與護理。新編內外科護理學
12. 蔡秀鸞（校閱）(2019).重症護理學.永大.