一位胸部鈍傷導致雙側氣血胸之急診照護經驗

Nursing experience with hemopneumothorax caused by chest contusion in emergency department

10.6647/CN.202003_27(1).0011

田政斌(Jeng-Bin, Tian)

氣血胸 ； 氣體交換障礙 ； 疼痛 ； 焦慮 ； hemopneumothorax ； gas exchange barrier ； pain ； Anxiety

彰化護理

27卷1期（2020 / 03 / 01）

86 - 96

繁體中文

本文敘述個案高處墜落致左肋骨折合併氣血胸入住急診之護理經驗。個案除須忍受胸部外傷引起的呼吸困難及急性疼痛，又因疾病預後和轉院治療的不確定性產生焦慮，筆者於照護期間（2017年08月07日20:36至2017年08月08日00:40）以Gordon十一項健康功能作為評估工具，透過觀察、照護及家屬會談收集與分析，歸納健康問題為：氣體交換障礙、急性疼痛、潛在危險性感染、焦慮、照顧者角色緊張之健康問題。於急診照護中，觀察病患呼吸型態、提供養氣及維持舒適半坐臥位，教導噘嘴式呼吸等護理措施改善呼吸困難;鼓勵患者說出疼痛感受、觀察面部表情、監測病患疼痛指數、協助胸管固定避免不必要拉扯等以降低疼痛指數。與家屬建立良好關係，主動傾聽與關懷，鼓勵病患及家屬說出不適及焦慮感受，澄清解釋病情及支持安撫及協助辦理轉院手續。急診照護以維持病患生命徵象穩定及提供病患舒適為主，但也需同理及滿足個案及家屬對癒後和照護治療不確定性心理需求。期盼由此急診照護經驗分享，提供急診同仁照護此類個案進一步之參考。本文因篇幅限制，無法列出各護理問題做詳述，因此僅摘錄氣體交換障礙、急性疼痛、焦慮健康問題與同仁做分享。

This article describes the nursing experience of the left ribs fracture combined with pneumohemothorax in the emergency department. In addition to suffering from dyspnea and acute pain caused by chest trauma, the case is also anxious due to the uncertainty of the disease and the treatment of transfer. The care period lasted from August 7 20:36 to 8 00:40, 2016.Data were collected through observation, caring and interview according to Gordon Functional Health Assessment guide. The nursing problems identified included gas exchange barrier, acute pain, risks for infection, anxiety and caregiver role strain. In emergency care, observe the patient's breathing pattern, provide gas and maintain a comfortable semi-fowler's position, teach Pursed-lip breathing and other nursing intervention to improve dyspnea; encourage patients to express pain, observe facial expression, monitor patient pain index, assistance the chest tube fixed well to avoid unnecessary pulling to reduce the pain index. Emergency care is to maintain the patient's vital signs and provide comfort to the patient, but it is also necessary to satisfy the psychologic needs of the case and family after the recovery and care treatment uncertainty. Expect to share this experience in emergency care and provide further reference for emergency care of such cases. Due to space limitations, this article cannot list the various nursing problems. Therefore, only the gas exchange barrier, acute pain, anxiety health problems to share.

1. 彭婉林,吳曉芬,林錦穗(2016)。照顧一位塵肺症個案之護理經驗。嘉基護理，16(1)，30-40。
   連結：
2. Arshad, H.,Young, M.,Adurty, R.,Singh, A. C.(2016).Acute pneumothorax.Critical care nursing quarterly,39(2),176-189.
3. IASP(May,22,2012) .IASP Taxonomy. retrieved from website: https://www.iasp-pain.org/Taxonomy
4. lekdemir, B.,Kaya, N.(2016).Effect of family presence on pain and anxiety during invasive nursing procedures in an emergency department: A randomized controlled experimental study.International emergency nursing,24,39-45.
5. Majercik, Sarah,Fredric, M(2017).Chest Wall Trauma.Thoracic Surgery Clinics,27(1),113-121.
6. Molnar, T. F.(2017).Thoracic Trauma: Which chest tube when and where?.Thoracic surgery clinics,27(1),13-23.
7. Pompili, C.,Salati, M.,Brunelli, A.(2017).Chest tube management after surgery for pneumothorax.Thoracic surgery clinics,27(1),25-28.
8. Singh Lamba, T.,Sharara, R. S.,Leap, J.,Singh, A. C.(2016).Management of Respiratory Failure.Critical care nursing quarterly,39(2),94-109.
9. Yap, D.,Ng, M.,Chaudhury, M.,Mbakada, N.(2018).Longest delayed hemothorax reported after blunt chest injury.The American journal of emergency medicine,36(1),171–e1.
10. 李仁智(2014).胸部影像學.台灣:台灣愛思維爾.
11. 胡月娟（校閱）(2015).內外科護理學上冊.台北市:華杏.
12. 劉致如,徐梅玉,陳明婉(2014)。一位溺水導致急性肺損傷個案之急診護理經驗。高雄護理雜誌，31(2)，35-43。
13. 衛生福利部統計處(2017，9月21日)‧民國105年死因統計年報電子書‧取自https://dep.mohw.gov.tw/DOS/lp-3352-113.html
14. 謝霖芬(2017)。肌肉骨關節疼痛的藥物治療。健康世界，485，11-12。