腹部手術後病人面臨呼吸窘迫症候群之加護經驗

Patient Experience in Respiratory Distress Syndrome After Abdominal Surgery

10.6647/CN.201906_26(2).0006

陳碧鳳(Pi-Feng Chen)；楊淑溫(Shu-WenYang)

呼吸窘迫症候群 ； 急性疼痛 ； 傷口照護 ； 焦慮 ； Respiratory distress syndrome ； acute pain ； wound care ； anxiety

彰化護理

26卷2期（2019 / 06 / 01）

27 - 41

繁體中文

本文旨在描述一位腹部手術後病人面臨呼吸窘迫症候群之加護經驗，護理期間自2014年7月3日至7月18日，筆者藉由臨床照護、身體評估、查閱病歷、與個案筆談和主要照顧者會談等方式收集資料，並運用Maslow人類需求理論，進行整體評估與分析，歸納主要護理問題：急性疼痛、呼吸機戒斷反應功能異常、組織完整性受損及焦慮。護理照護期間建立良好護病關係與信任感，先讓個案認識身上的管路及周遭醫療儀器，再讓個案接受它們存在的必要性，接著帶領個案及家屬共同參於呼吸訓練及傷口照護過程，藉由家屬支持、醫療團隊介入、提供適量止痛劑及鎮靜劑，能改善焦慮、促進傷口癒合，使個案順利渡過急性呼吸窘迫症候群造成生、心理失衡，最後成功脫離呼吸器。建議製作胸腔復健及呼吸訓練團體衛教短片，播放於家屬休息室，促進家屬共同參於訓練過程。期許本文的護理經驗分享，提供類案照護之參考。

The purpose of this article was to explore nursing experience of a patient with respiratory distress syndrome after abdominal surgery. Nursing care period was from July 3 to July 18, 2014, the author used clinical care, physical assessment, medical records, and case discussion. The caregiver interviewed and other means collect data and use Maslow's human needs theory to conduct an overall assessment and analysis, summarizing the main nursing issues: acute pain, abnormal ventilator withdrawal response, impaired tissue integrity and anxiety. Established a good relationship between illness and trust during care. Let the case know the pipeline and surrounding medical equipment,accept the necessity of existence, and then lead the case and family members to participate in the breathing training and wound care process. Through family support, medical team intervention, and the provision of appropriate analgesics and sedatives, it can improve anxiety and promote wound healing, so that the case can survive the acute respiratory distress syndrome smoothly and cause psychological imbalance, and finally successfully divorced used of the respirator. It is recommended to make a short video of the chest rehabilitation and breathing training group, which will be played in the family lounge to promote family members to participate in the training process. We wished by sharing of nursing experience in this article would provide reference for case care.

1. Cohen, M.,Quintner, J.,van Rysewyk, S.(2018).Reconsidering the International Association for the Study of Pain definition of pain.Pain Reports,3(2),e634-e634.
2. Cour, A.,Sanchez, L.,Sinquet, J. C.,Gaudard, P.,Eliet, J.,Barge, F.,Colson, P.(2012).ARDS and ECMO, an Update on Critical Care Nursing.Open Journal of Nursing,2(S),301-306.
3. Keegan, L.(2003).Therapies to reduce stress and anxiety.Critical CareNursing Clinics of North America,15,321-327.
4. Lu, C. F.,Chen, M. C.,Shu, S. C.(2012).An Overview of Generalized Anxiety Disorder and Reflections on the Effective Nursing Care of Patients with This Disorder.The Journal of Psychiatric Mental Health Nursing,7(1),1-10.
5. NCCN(2018). Adult Cancer Pain. Retrieved from Research on Poverty Alleviation website: https://www.nccn.org/professionals/physician_ gls/pdf/pain.pdf
6. North American Nursing Diagnosis Association International,高紀惠（譯）,曾詩雯（譯）,莊琬筌（譯）(2012).NANDA International護理診斷：定義與分類2012-2014.臺北市:華杏.
7. Rocchetti, S.,Braga, M.(2012).Glycemia, nutrition and wound healing.Nutritional Therapy & Metabolism,30(3),121-128.
8. Wong, H. L. C.,Lopez-Nahas, V.,Molassiotis, A.(2001).Effects of music therapy on anxiety in ventilator-dependent patients.Heart & Lung: The Journal of Acute & Critical Care,30(5),376-387.
9. 于博芮,蔡新中,蔡新民,張美娟,黃靜君,林秋玉,胡名霞(2012).最新傷口護理學.臺北市:華杏.
10. 余婕榛,黃惠璣(2010)。加護病房中化學性約束的使用與護理。護理雜誌，57(6)，83-88。
11. 林玟秀(2013)。照護一位呼吸窘迫症候群併發呼吸衰竭之護理經驗。新臺北護理期刊，15(1)，123-132。
12. 林祐如,賴美玉(2012)。照護一位因脊髓損傷引發疼痛與焦慮病患之護理經驗。若瑟醫護雜誌，6(1)，96-106。
13. 柯獻欽(2009)。吸入一氧化氮（Inhaled Nitric Oxide, iNO）在急性呼吸窘迫症候群（Acute Respiratory Distress Syndrome, ARDS）之運用。當代醫學，36(2)，125-138。
14. 胡文郁,陳宛榆,羅淑芬,陳書毓,黃翰心,陳幼貴(2011)。成人癌症疼痛臨床照護指引。腫瘤護理雜誌，11，87-127。
15. 胡淑琴,李茹萍(2006)。吸氣肌肉訓練對呼吸器依賴患者脫離之成效。台灣醫學，10(5)，586-594。
16. 黃健裕,李毓芹,陽光耀(2013)。急性呼吸窘迫症候群診斷定義的新變革─從AECC到柏林定義。內科學誌，24(2)，79-84。
17. 靳燕芬(2007)。傷口換藥疼痛護理。護理雜誌，54(3)，87-91。
18. 潘雪幸,張慕民,蕭存芳,張秉宜,吳品萱(2008)。加護病房病人之壓力源及其護理。長庚護理，19(3)，353-359。
19. 鄭婉如,古雅如,馬瑞菊(2010)。一位呼吸衰竭插管病患急性疼痛之護理經驗。領導護理，11(3)，46-59。
20. 賴怡樺,施富金(2009)。成功脫離呼吸器之影響因素與護理。榮總護理，26(4)，382-387。
21. 嚴月悅(2010)。心臟手術病患於加護病房照護需求。品質月刊，46(9)，39-42。

1. 黃雅君,曾玲雅,陳妍榛,徐雯娟(2022)。提升外科加護病房「腹部手術病人肺部復健運動」執行率。長庚護理，33(3)，46-58。