照護一位肺阻塞病人使用非侵襲性正壓呼吸器之護理經驗

Nursing Experience of Caring for a Patient With Chronic Obstructive Pulmonary Disease Who Received Noninvasive Positive Pressure Ventilation

10.6142/VGHN.202303_40(1).0012

許慈方(Tzu-Fang Hsu)；洪正隆(Cheng-Lung Hung)

肺復原 ； 非侵襲性正壓呼吸器 ； 低效性呼吸型態 ； pulmonary rehabilitation ； noninvasive positive pressure ventilation ； ineffective breathing pattern

榮總護理

40卷1期（2023 / 03 / 01）

103 - 110

繁體中文;英文

本文描述一位52歲女性罹患肺阻塞，因反覆急性發作導致呼吸衰竭，使用非侵襲性正壓呼吸器介入肺復原運動之照護經驗。護理期間2022年1月10日至1月30日，筆者藉由觀察、會談、身體評估、連續性照護、病歷查閱及與醫療團隊討論方式收集資料，運用Gordon十一項健康功能型態評估，確認病人有低效性呼吸型態、焦慮、無效性健康維護能力等健康問題。透過非侵襲性正壓呼吸器緩解呼吸衰竭症狀，以病人為中心規劃肺部復健運動，增強呼吸肌耐力維持足夠氧合；因長期使用非侵襲性正壓呼吸器導致病人情緒焦慮不安，出院前協同出院準備服務個管師與其共同擬定自我照護計畫，提供居家呼吸器照護技能等相關資訊，安排營養師給予適當飲食衛教，提升返家後生活品質，降低再入院率，有效降低病人焦慮並建立良好護病關係。有鑑於急性照護及長期照護之差異，建議病房在職教育安排居家呼吸器簡介及基本操作流程等長照相關資訊，有效整合及強化全人照護品質。

This article describes our nursing experience of caring for a 52-year-old woman with respiratory failure due to chronic obstructive pulmonary disease. The patient received noninvasive positive pressure ventilation. The nursing period was January 10 to 30, 2022. Relevant data were collected through observation, interviews, physical examination, continual care, medical records, and discussion with the corresponding health-care team. The 11 functional health patterns proposed by Gordon were used to access ineffective breathing patterns, anxiety, ineffective health maintenance ability, and health status. Noninvasive positive pressure ventilation was performed for treatment and symptom relief. Patient-centered lung rehabilitation exercises were designed to enhance respiratory muscle endurance and maintain adequate oxygenation. The necessity of long-term ventilation may evoke fear and anxiety in patients. Discharge planning with patients to ensure hassle-free home ventilation care may help alleviate their negative emotions and establish a healthy nurse-patient relationship. In our hospital, personalized self-care plans are designed together with patients. We also provide information on disease and effective self-care skills in addition to diet plan and nutrition consultations to improve patients' quality of life after discharge and reduce the likelihood of readmission. Patient education on long-term care must be incorporated into clinical practice. Educating patients who require long-term home ventilation about the basic concept of their procedure and the operation of the relevant surgical device may improve the quality of medical care.

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