照護一位學齡期兒童一氧化碳中毒之急診護理經驗

The Emergency Nursing Experience from Caring for a School-age Child with Carbon Monoxide Poisoning

10.29494/LN.202203_23(1).0008

洪鈺潔(Yu-Chieh Hong)；陳秀玲(Hsiu-Ling Chen)

一氧化碳中毒 ； 學齡期 ； 急診護理 ； carbon monoxide poisoning ； school age ； emergency care

領導護理

23卷1期（2022 / 03 / 01）

91 - 103

繁體中文

本文描述一位11歲學齡期個案因一氧化碳中毒之急診護理經驗，急診照護期間為2020/3/20 23：12PM至3/21 10：50AM，藉由觀察、會談、查閱病歷、傾聽及直接護理收集資料，運用Gordon十一項健康功能評估為架構，確立個案主要健康問題為氣體交換障礙、潛在危險性窒息、焦慮。協助給予氧氣使用，以排出體內一氧化碳，改善體內組織缺氧及增加細胞存活，減低因體內一氧化碳過多造成的毒性作用；評估意識變化及呼吸型態，監測末梢血氧濃度並安排高壓氧治療，使個案生命徵象及意識逐漸恢復穩定，臨床症狀獲得改善；此外，個案因處於陌生環境及受近期新冠肺炎疫情之影響，加上擔心自己及母親病況，害怕健康受威脅而產生不安和焦慮，首先以主動關懷、傾聽來建立良好的護病關係，引導其有正向想法及提供個別性措施來改善焦慮，經由正確的治療及整體性照護，降低個案體內一氧化碳血紅素及改善焦慮情形，亦建議本院可在電子網頁上設置兒童焦慮量表評估單及相關兒童心理照護資訊等，作為照護及評估需求之輔助使個案健康出院返家，期望藉由此次護理經驗，提供急診護理人員照顧此類病患之參考。

This article describes an 11-year-old school age patient, who came to Emergency Department (ED) due to carbon monoxide poisoning. During the stay at ED from 23:12 on March 20 to 10:50 on March 21, 2020, data was collected through observation, interviews, access to medical records, listening and direct care; applies Gordon's eleven health function assessments as a framework to confirm patient's main health issues as gas exchange impaired, potential risk of suffocation, and anxiety. Assist eliminating carbon monoxide by supplying oxygen to decrease tissue hypoxia and increase cell survival rate, reduce toxic caused by excessive carbon monoxide in the body; evaluate changes in conscious level, breathing patterns and monitor peripheral blood oxygen saturation and arrange hyperbaric oxygen therapy until patient's vital signs and consciousness gradually stabilized, and clinical symptoms improved. In addition, patient was in anxious condition owing to unfamiliar environment in ED and threatened by COVID-19 epidemic, as well as worrying about the health condition of both herself and her mother, all of those health situations that caused stress and anxiety. Firstly, establish a trusting nurse-patient relationship with active care and listening, then guide patient to retain positive thinking and provide individual measures to reduce anxiety. Through appropriate treatment and holistic care; lower carbon monoxide-heme level and improve the patient's anxiety. It is also recommended that the hospital set up a child anxiety scale assessment data and relevant psychological care information on the internet. The assistance in assessing the needs of care will enable the case to be discharged from the hospital and return home in good health. It is hoped that this nursing experience will provide a guideline for emergency care staff when caring for such patients.

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