協助一位呼吸道阻塞病人面臨氣切手術抉擇衝突的急診護理經驗

The Emergency Nursing Experience from Helping a Patient with Airway Obstruction Faced Decisional Conflict for Tracheostomy

黃琳諭(Lin-Yu Huang)；高淑美(Shu-Mei Kao)；郭芳里(Fang-Li Kuo)；張淑美(Shu-Mei Chang)；劉寶玲(Pao-Ling Liu)

呼吸道阻塞 ； 氣切 ； 抉擇衝突 ； airway obstruction ； tracheostomy ； decisional conflict

嘉基護理

24卷1期（2024 / 06 / 01）

43 - 55

繁體中文;英文

本文探討一位因腫瘤壓迫造成氣道阻塞面臨氣切手術的個案，病人在短時間內必須做出重大抉擇的急診護理經驗。照護期間自2022年7月25日08:00～7月26日18:00止，運用Gordon 11項健康功能型態評估，以觀察、會談與身體評估等方式收集資料，發現個案有呼吸道清除功能失效、疼痛與抉擇衝突等健康問題。照護過程中筆者以抽痰、氧氣鼻導管，教導深呼吸咳嗽的技巧，採半坐臥姿以維持呼吸道順暢；以藥物、避免壓迫及觸碰疼痛部位，採舒適臥位以減輕不適，用聽音樂、打坐深呼吸、精油塗抹轉移疼痛感；在心理方面，鼓勵個案表達心中感受，同理個案的負面想法，並以正向的態度回應；經醫療團隊解釋病情，結合病人與家屬的想法，提供氣切與氣管內插管之優缺點比較，協助個案做出抉擇。建議急診護理人員面對氣切抉擇衝突的病人，在考量病況發展與自我價值觀下，分析不同治療的利弊得失，發展出最合適的照護計畫。

This article discusses the emergency nursing experience of a patient who faced tracheostomy due to airway obstruction caused by tumor compression, and the patient had to make major choices in a short period of time. The patient have to make major decisions in a short period of time. Data was collected from 08:00 July 25, to 18:00 July 26, 2022, by observation, interview, and physical assessment, with Gordon's 11 functional health pattern model. It was found that the case had three health problems: airway clearance failure, pain and decisional conflict. During the nursing process, the author used sputum suction, high-flow nasal cannula, and teaches the skills of deep breathing and coughing, adopted a half-sitting and lying position to maintain a smooth airway; used drugs, avoided pressure and touching the painful part, adopted a comfortable lying position to relieve discomfort, and listened to music, meditate and take deep breaths, apply essential oils to relieve pain; in terms of psychology, encourage patients to express their inner feelings, empathize with their negative thoughts, and respond with a positive attitude; After the medical team explained the condition, combined with the thoughts of the patient and family members, a comparison of the advantages and disadvantages of tracheostomy and endotracheal intubation was provided to assist the case in making a decision. It is recommended that emergency nurses analyze the pros and cons of different treatments based on the patient's condition and self-worth to develop the most appropriate care plan when faced with a patient with a decisional conflict of tracheostomy.