協助一位支氣管擴張症病人適應非侵襲性的正壓呼吸器之護理經驗

The Nursing Experience of Adaptive Non-invasive Positive Preeure Ventilator for Bronchiectasis Patient

黃琳蓁(Lin-Chen Huang)；林家慧(Jia-Huei Lin)；李玉英(Yu-Ying Li)；張聿仁(Yu-Jen Chang)

支氣管擴張症 ； 非侵襲性正壓呼吸器 ； 低效性呼吸型態 ； bronchiectasis ； non-invasive positive pressure ventilator ； ineffective breathing pattern

若瑟醫護雜誌

13卷1期（2019 / 06 / 01）

88 - 100

繁體中文

本文描述一位支氣管擴張症病人，因感冒引發呼吸衰竭使用非侵襲性正壓呼吸器的照護經驗。自2015年5月5日至2015年5月20日照護期間，藉由觀察、會談、身體評估及病歷查閱等方式收集資料，以Gordon十一項健康功能評估方式進行身體、心理、社會及靈性等評估，綜合分析整理後確立主要健康問題有：低效型呼吸型態、營養少於身體所需、無望感。照護期間透過非侵襲性正壓呼吸器緩解呼吸衰竭症狀，介入改善個案營養狀況及肺部訓練活動，增加其整體活動力及呼吸肌耐力；在心理方面，個案面臨長期使用非侵襲性正壓呼吸器以預防呼吸衰竭，因此造成負面心理衝擊，對生命無望失去控制感，筆者協助個案減輕使用非侵襲性正壓呼吸器的不舒適感，以主動關懷及傾聽給予心理支持，釐清個案對疾病及自我照顧的疑慮，提供居家呼吸照護資訊協助家屬參與照顧，減輕個案的焦慮及不安重拾對醫療團隊的信心，並能接受及適應非侵襲性正壓呼吸器，進而能正向因應日後健康照護問題，成功出院返家。盼藉此護理經驗提供臨床照護非侵襲性正壓呼吸器個案之參考。

This article reports a nursing experience of caring for a middle-aged male with the lymphoma after the hematopoietic stem cell transplantation complicated with the bronchiectasis, who developed the acute respiratory failure due to the influenza and used the noninvasive positive pressure ventilators (NIPPV). The patient suffered from the bronchiectasis and had many negative thoughts for his life and denied the treatments. During the nursing period from May 5 to 20, 2015, the author collected the data by the observation and consultation and physical examination and chart reviews and evaluated the patient by the Gordon 11 Function Health Patterns. The confirmed healthy problems were as following: ineffective breathing pattern and nutrition less than body requirements and hopelessness. In the nursing period, we used the NIPPV to alleviate the symptoms of the respiratory failure and intensive nutrition support and pulmonary rehabilitation to enhance the general motility of the patient and strength of the respiratory muscles. In the psychological aspect, the patient had to face with the impact of the long-term NIPPV-dependent condition and loss of personal control and hopelessness to the life. The author cared the patient actively and sincerely and listened to him and gave psychological support and clarified the worries to the patient about the disease and self-care ability and provided the information of the home respiratory care. We assisted the family to join the general patient-care and alleviated the worries and anxiety of the patient and gave the confidence to the patient to the medical term. We hoped the patient can adapt the NIPPV and face the worries about the long-term health care frankly and discharged to back home smoothly. We would like to share the nursing experiences to the clinical nursing staffs.

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