一位850公克早產兒之護理經驗

Nursing Experience of a 850g Premature Baby

10.6692/KJN-2007-24-2-2

范惠珍(Hui-Chen Fann)；林盈慧(Yin-Hui Lin)

極低出生體重 ； 早產兒 ； 支持性照護 ； Extremely low birth weight ； premature baby ； supportive care

高雄護理雜誌

24卷2期（2007 / 11 / 01）

17 - 29

繁體中文

本文主要在探討一位孕期25(上標 +3)週出生體重850公克之早產兒，由於家屬擔心早產兒易罹患各種合併症，而簽署放棄救助同意書；但經過診治之後，早產兒病情逐漸穩定，且無產生嚴重合併症，案母及家屬能重拾信心進而接納早產兒的照護過程。筆者為個案住院期間之主護護理師，以系統性的觀察與會談，評估收集個案的病況、生理、早產兒行為變化及家庭評估後，確立護理問題，依此進行護理措施，提供整體性的護理。照護期間主要的護理問題有：氣體交換功能障礙、混亂性嬰兒行為、潛在危險性父母－嬰兒依附關係改變。藉由呼吸器及氧氣供給，和持續胸腔物理治療，並給予案母支持性的照護及協助袋鼠式護理，讓案母參與照護過程，在經個案氧飽和度上升及拔除氣管內管、體重持續穩定增加中，提升案母照顧信心而願意全心全意來學習早產兒之照護。期望以此經驗作為日後護理人員在照顧極低出生體重早產兒之參考。

This article explores the case of a premature baby of the extremely low birth weight of 850g, who was born at gestational age of 25(superscript +3) weeks. However, considering the baby suffered from various kinds of premature complications, the family signed a ”do not resuscitate” document. Fortunately, after the treatment, the baby's condition gradually became stable and severe complications were avoided, so the family was able to rebuild confidence and accepted the nursing process of (this) premature baby. The author is the chief caregiver during the premature baby's hospital stay. Information about the baby was collected with systemic observation and conversation. Firstly, the baby's nursing problem was identified and then a nursing plan was developed for the provision of total care. The main health nursing problems of the care were ”gas exchange impaired”, ”infant behavior disorganized” and ”attachment impaired with parent/infant”. Through use of a mechanical ventilator, oxygen supply, chest physical therapy, and provided supportive care and assistance to the mother of the baby (to participate in kangaroo care and let her have increased involvement in care), then the premature baby's condition became stable and this rebuilt the confidence of the mother in her perceived ability to care for the baby. It is expected that this experience can be a reference for nursing staff looking after premature babies of extremely low birth weight in the future.