運用發展性照護於一位高膽紅素血症新生兒接受換血治療之護理經驗

The experience of applying developmental care for an infant with hyperbilirubinemia in receiving blood transfusion therapy

10.29494/LN.201912_20(4).0007

許曉竹(Hsiao- Chu Hsu)；郭惠貞(Hui-Chen Kuo)

高膽紅素血症 ； 換血治療 ； 新生兒發展性照護 ； developmental care ； Hyperbilirubinemia ； Exchange transfusion therapy

領導護理

20卷4期（2019 / 12 / 01）

82 - 93

繁體中文

本文探討一位診斷高膽紅素血症新生兒接受換血治療之護理經驗。護理期間自2017年6月1日至6月10日，運用系統性身體評估、觀察、查閱相關資料、與父母親會談等方式收集資料，進行整體性評估，確認健康問題有潛在危險性腦損傷、混亂性嬰兒行為、照顧者角色緊張等。照護期間提供個別性護理，監測膽紅素值及輸出入量變化，避免膽紅素值過高引起的腦神經功能損傷；運用發展性照護採集中護理，照護時動作輕柔、維持姿勢及築巢擺位，維持安靜舒適環境以減少耗氧，促使個案穩定生長；提供父母親相關照護資料、給予正向鼓勵支持，經協助下讓父母主動參與日常生活照護，建立良好親子的依附關係。由於換血治療需專業性的照護，建議建立新生兒換血治療護理標準作業流程，減少換血合併症及感染發生，以提升護理專業照護品質，冀望藉此照護經驗，作為臨床護理人員日後照護參考。

The paper investigates a nursing experience of caring for an infant with hyperbilirubinemia in receiving an exchange transfusion. The duration of the nursing care period was from June 1st to 10th in 2017. Systematic physical evaluations, observation, review of literature, and interviews with the parents of the infant were methods applied in holistic assessment. As diagnosed, potential risk of brain damage, chaotic infant behavior, and intense role of caregiver were included as part of the nursing care plan. Patient-centered care was provided in the duration of hospitalization, monitoring bilirubin value and changes in output volume is applied to prevent brain nerve function damage from excessive bilirubin value. In addition, providing concentrate nursing care to avoid the patient's rest being interrupted, gentle physical movement and appropriate physical configurations with sympathy. For reducing the patient's oxygen consumption, a quiet and comfortable environment was also arranged to maintain steady growth for the patient in this case. Also, the nursing team provided information to newborn baby's parents and empowering their capability in caring for their infant. The client's parents were encouraged to initiate their infant's daily caring routine and building up a good parent-child dependency relationship. The blood transfusing therapy of a newborn baby requires professional nursing care in the pediatric ward. The authors recommend a standard operating procedure for neonatal blood transfusion therapy requirement to be developed in order to reduce the incidence of exchange transfusion complications and infection to ensure the quality of nursing care. Hopefully this caring experience can be uses as a reference to clinical caring team in the future.

1. 王淯文,張瑩如(2015)。發展照護之理論與研究趨勢。護理雜誌，62(5)，89-95。
   連結：
2. 唐鈺婷,康豑云,蔣立琦(2016)。以家庭為中心重症病人家屬的護理照護。領導護理，17(1)，2-13。
   連結：
3. Carr, J. P.,Burgner, D. P.,Hardikar, R. S.,Buttery, J. P.(2017).Empiric antibiotic regimens for neonatal sepsis in Australian and New Zealand neonatal intensive care units.J Paediatr Child Health,53(7),680-684.
4. Hakan, N.,Zenciroglu, A.,Aydin, M.,Okumus, N.,Dursun, A.,Dilli, D.(2015).Exchange transfusion for neonatal hyperbilirubinemia: an 8-year single center experience at a tertiary neonatal intensive care unit in Turkey.J Matern Fetal Neonatal Med,28(13),1537-1541.
5. Singla, D. A.,Sharma, S.,Sharma, M.,Chaudhary, S.(2017).Evaluation of Risk Factors for Exchange Range Hyperbilirubinemia and Neurotoxicity in Neonates from Hilly Terrain of India.Int J Appl Basic Med Res,7(4),228-232.
6. 王淑芳,高美玲(2013)。營造新生兒中重度病房的親善哺乳環境。護理雜誌，60(1)，11-16。
7. 陳月枝（校閱）(2015).實用兒科護理.台北:華杏.
8. 黃媚秋,謝秋菊,蔡蓮花,鄒綉菊,黃麗萍,劉慈慧(2017)。運用統合發展照護理論於一位重症早產兒之護理經驗。高雄護理雜誌，34(2)，84-95。
9. 謝武勳,吳美環,陳倩儀(2014).實用新生兒科醫療手冊.台北:金名.