一位肌萎縮性側索硬化症病人成功脫離呼吸器之照護經驗

Nursing Experience of an Amyotrophic Lateral Sclerosis Patient to Successfully Weaning of Mechanical Ventilation

10.3966/102673012017122804009

賴婉甄(Wan-Jan Lai)；賴美玉(Mei-Yu Lai)；張淑華(Shu-Hua Chang)

肌萎縮性側索硬化症 ； 脫離呼吸器 ； 無望感 ； amyotrophic lateral sclerosis ； wean from mechanical ventilation ； hopelessness

長庚護理

28卷4期（2017 / 12 / 01）

677 - 685

繁體中文

本文描述一位肌萎縮性側索硬化症的個案，因疾病進展導致呼吸衰竭合併使用呼吸器，接受遙不可及的呼吸器脫離訓練，所面臨的身體及心靈衝擊進而產生無望感之護理經驗，個案意識清楚卻得知無法治癒的疾病進展，面臨艱困的呼吸器脫離訓練，身體心靈上雙重威脅，出現否認、無望，故引發筆者探討之動機。護理期間自2014年9/12至10/15，以觀察、家屬訪談、身體評估、實際照護及查閱病歷等方式收集資料，運用Gordon十一項健康功能型態評估，確立個案主要護理問題有：呼吸道清除功能失效、營養狀況改變及無望感之健康問題。護理過程中筆者主動協助個案執行被動胸腔復健運動，增進胸部肌肉力量及清除痰液能順利進行呼吸訓練，並成功脫離呼吸器；運用跨團隊整合照護共同介入與評估，調整適切之營養配方，增進個案營養攝取以獲得身體所需；並藉由陪伴個案及主動傾聽家屬想法，協助個案正向態度面對疾病及後續治療，肯定自己與病共存的事實。另外，建議醫護團隊透過家庭會議共同討論進行氣管切開術，或是選擇安寧緩和醫療，儘早降低個案及家屬所承受的身心煎熬，也讓個案度過有品質的餘生階段。

This article describes the despairing nursing experience of physical and psychological impact in a patient with amyotrophic lateral sclerosis suffering from respiratory failure combined use of mechanical ventilator due to disease progression and receiving the unattainable training of weaning from mechanical ventilation. The motive of this study is the case appears to deny and hopeless because of realizing the physical and spiritual double threats of incurable disease progression and difficult training of weaning from mechanical ventilation. Data were collected from observation, discussion with the family members, physical assessment, direct care, and chart review during a period of nursing care from September 12, 2014 to October 15, 2014. Based on Gordon's eleven functional health patterns, the main nursing problems of patient confirmed included: ineffective method of clearing airway, altered nutritional status, and hopelessness. During the nursing process, the author helped the case to train his breathing by having passive chest muscle rehabilitation activities, improving the strength of chest muscle and clearing sputum, and successfully wean from mechanical ventilation. Appropriate adjustment of the nutritional formula enhances case nutritional intake to get the demand of body by using cross-team integrated care to joint intervention and evaluation. Assisted the patient toward disease, subsequent treatment and the fact of disease with forward attitude through companionship and active listening the idea of his family. In addition, the author recommends that health care team through a family meeting to discuss the tracheotomy or select hospice palliative care to reduce the sufferings of the patient and his family and allow the patient to spent the rest of his quality life.

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