一位創傷患者脫離呼吸器的護理經驗

A Nursing Experience of a Traumatic Patient from the Respirator

10.6647/CN.201906_26(2).0010

陳惠美(Hui-Mei Chen)

創傷 ； 脫離呼吸器 ； 護理經驗 ； Trauma ； ventilator weaning ； nursing experience

彰化護理

26卷2期（2019 / 06 / 01）

83 - 94

繁體中文

本文為探討一位35歲女性因車禍導致腹部及雙下肢骨折，接受手術後脫離呼吸器之護理經驗。護理期間於2017年4月26日至5月8日，藉由直接照顧、觀察、互動方式收集資料，運用Gordon十一項健康功能型態評估，發現有「呼吸道清除功能失效」、「身體活動功能障礙」、「焦慮」護理問題。在加護病房接受治療時，因插氣管內管無法言語及下肢活動功能受損，擔心無法正常活動及照顧小孩，讓個案產生挫折、對未來感到害怕而有焦慮及不安全感，進而影響到呼吸器訓練，以致延長脫離呼吸器時間，增加住院天數，筆者以個案與家庭為中心，協同醫療團隊予以病情解釋、關懷陪伴、情感支持、音樂治療及個人宗教信仰護理措施介入，增進對疾病了解、鼓勵個案表達情緒降低焦慮及不安全感並配合胸腔復健及下肢復健運動的指導與執行，讓個案儘早成功脫離呼吸器。因此，透過此個案報告，與護理人員分享重視急、重症患者焦慮的問題，協助身、心、社會適應之重要性，提供護理人員日後臨床照護之參考。

This article explores the experience of a 35-year-old woman who has suffered from a fracture of the abdomen and lower extremities in a car accident and has been removed from the respirator after surgery. During the care period, data were collected through direct care, observation and interaction. Gordon's eleven health functional assessments were used to identify problems with respiratory tract dysfunction, physical activity dysfunction and anxiety. When receiving treatment in the intensive care unit, the intubation tube is unable to speak and the function of the lower limbs is impaired, fearing that it will not be able to operate normally and take care of the child, causing frustration in the case, fear of the future, anxiety and insecurity, and thus affecting breathing Training, so as to extend the time of resuscitation, increase the number of hospital stays, the author is based on case and family, collaborative medical team to explain the condition, care, emotional support, music therapy and personal religious care interventions to improve understanding of the disease, Encourage cases to express emotions, reduce anxiety and insecurity, and cooperate with the guidance and implementation of chest rehabilitation and lower limb rehabilitation exercises to allow cases to successfully escape from the respirator as soon as possible. It is suggested that flexible adjustments will increase family members' time and companionship to alleviate the anxiety of the case. After the case is discharged, the patient can continue to follow up and assess the self-care ability and whether there is psychological stress adjustment to provide continuous care. Therefore, through this case report, we share with the nursing staff the importance of attaching importance to the anxiety of critically ill and critically ill patients, assisting the importance of physical, mental and social adaptation, and providing reference for future nursing care of nursing staff.

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