一位嚴重特殊傳染性肺炎重症病人之照護經驗

A Patient with COVID-19

10.6386/CGN.202304/SP_34_1.0001

林利蓁(Li-Chen Lin)；王惠貞(Huei-Jhen Wang)；李淑秋(Shu-Chiu Lee)；鄭麗華(Li-Hua Cheng)

嚴重特殊傳染性肺炎 ； 重症病人 ； 社交隔離 ； COVID-19 ； Critically Ill Patients ； Social Isolation

長庚護理

34卷增訂刊1（2023 / 04 / 01）

1 - 12

繁體中文;英文

本文探討一位罹患「嚴重特殊傳染性肺炎」（coronavirus disease-2019, COVID-19）引起呼吸窘迫入住加護病房隔離治療之經驗，治療過程中個案經歷呼吸衰竭置放氣管內管治療，面對罹患新興傳染病需隔離於重症病房，面臨此衝擊內心恐慌，照護過程具特殊性引發撰寫動機。照護期間自2021年6月1日至16日，以觀察、身體評估、遠距視頻及雙向溝通進行病人身、心、靈及社會等層面之評估，歸納出健康問題有：因感染嚴重特殊傳染性肺炎引發呼吸窘迫之氣體交換障礙、移除氣管內管後，出現嘴角流涎及吞嚥後嗆咳之吞嚥功能障礙、因高度傳染疾病需單獨隔離於病房產生社交隔離。照護全程中須採嚴密防護裝備，透過使用正壓呼吸器、俯臥治療及中醫輔助抑制病毒複製，逆轉嚴重肺炎擴散，成功移除氣管內管後，發生吞嚥困難，透過口腔吞嚥訓練，恢復由口進食。照護須採嚴密防護，醫護人員須穿戴防護衣進入病室，不易即時溝通，因此增設遠距視頻結合緊急呼叫鈴，隨時監測生命徵象變化。醫護團隊每日透過Line群組與家屬通話匯報病況。利用APP軟體獲取疾病相關訊息，增加對疾病掌控，降低其恐慌。期望藉此照護經驗，做為未來照護相關個案之參考。

This article narrates nursing experience from caring a patient with COVID-19 who was admitted to the ICU isolation room for respiratory distress and received intubation treatment. To face this emerging infectious disease that need to be isolated in the ICU, this patient had feeling of panic and fear through the care period, so it motivates me to investigate about this topic. During the care period from June 1st to June 16th, 2021, the health problems were evaluated by observation, physical evaluation, telemedicine, also to communicate with patient about the aspect of the patient's physical-mind-spirit. The health problems are summarized as follows: "impaired Gas Exchange" that causes respiratory distress, occurrence of "Swallowing Dysfunction", drooling and chocking after extubation, and "Social Isolation" due to highly consequence infectious diseases need to live in a single-person room for isolation and treatment. Strict protective equipment should be used throughout the isolation period, also use continuous positive airway pressure, prone position, and Chinese herbal medicine, which could inhibit virus replication and avoid the spread of severe pneumonia. After successfully extubation, if swall-owing difficulties occurs, the patient may restore oral eating after the oral swallowing training. In the pandemic, Medical care team must be securely guarded by wearing Personal Protective Equipment(PPE) to enter the isolation room for nursing care, it's quite difficult to communicate with patient, so the additional method is to use telemedicine by video combined with bells for emergency situation call, also we could be closely monitoring the patient's vital signs at any time. The medical team reports the patient's condition daily through the Line communication APP by a call with family members. Through this method, the patient and their family could get disease related information and understand about the disease condition and reduced their worry and anxiety. This author would like to share experience of nursing with other nursing professionals.

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