一位慢性阻塞性肺疾病病人之護理經驗

Caring Experience for a Patient with Chronic Obstructive Pulmonary Disease

10.29494/LN.202209_23(3).0008

李成恩(Cheng-En Lee)；林靖芸(Jing-Yun Lin)

慢性阻塞性肺疾病 ； 活動無耐力 ； 低效性呼吸型態 ； COPD ； activity intolerance ； inefficient breathing pattern

領導護理

23卷3期（2022 / 09 / 01）

104 - 118

繁體中文

隨著醫療的進步，人口老化問題逐年攀升，慢性阻塞性肺疾病佔十大死因第七名，死亡率為12.7%。本文描述一位因咳嗽、呼吸困難，近五年來常因慢性阻塞性肺疾病急性發作頻繁就醫，住院期間因呼吸困難需使用高濃度氧氣，若持續惡化，則需插管併呼吸器使用，對病情及預後感到擔憂，嚴重影響日常生活而產生焦慮，進而引發筆者深入探討的動機。護理期間於2020年6月8日至2020年6月19日照護期間，運用Gordon十一項功能性健康型態之評估為架構，運用直接照護、觀察、會談、身體評估等方式進行資料收集，發現個案有低效性呼吸型態／與急性發作造成無法足夠換氣有關、活動無耐力／與氧氣供需不平衡有關、焦慮／與擔心疾病對生命有威脅有關等三項健康問題。照護期間邀請個案及家屬共同參與治療計劃，教導肺復健及用藥遵從重要性，安排呼吸訓練計劃及監測營養狀況，促使呼吸肌耐力增加，鼓勵個案說出內心感受，減緩因疾病造成之焦慮，提升個案的自我認知及照護技巧，有效降低反覆入院情形，進而提升生活品質。期望藉由此護理經驗分享，提供臨床護理人員照護相關個案之參考。

Advancements in medical treatments have contributed to the problem of aging population as years goes by. Chronic Obstructive Pulmonary Disease (COPD) ranks seventh among the top ten causes of death, with a mortality rate of 12.7%. This article describes a patient who experienced coughing and breathing difficulties, and has to seek medical treatments frequently for acute COPD attacks in the last five years. During hospitalization period, the patient required high-concentration oxygen treatment for dyspnea and faced the possibility of intubation and mechanical ventilation if his condition deteriorated further. As a result, he became anxious about his condition and seriously affected his daily routine, which in turn prompt the author's motivation to in-depth discussion. This situation served as the author's motivation for conducting an in-depth discussion of the patient. During the nursing period from June 8 to June 19, 2020, data were collected using Gordon's Eleventh Functional Health Patterns as a framework; data was collected through direct care, observations, interviews, and physical assessments. It was found that the patient encounters three nursing-related health problems, these include inefficient breathing pattern related to insufficient ventilation while acute attack; activity intolerance related to unbalanced oxygen supply; and anxiety related to concerns regarding the possibility of disease being life-threatening. During nursing period, the patient and his family members were invited to participate in his treatment plan, during which they were taught the importance of lung rehabilitation and medication compliance; a breath training and nutrition monitoring plan was implemented; promote the improvement of the patient's respiratory muscle endurance; and the patient was encouraged to express his inner feelings. These measures helped to alleviate the patient's disease-induced anxiety, effectively reduced his frequency of hospital admission, and enhanced his quality of life. It is hoped that this nursing experience sharing can serve as a reference for clinical nursing staff when taking care of similar cases.

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