一位深頸部感染病患初次接受氣切手術之護理經驗

Nursing Experience of Deep Neck Infection Patients Receiving an Initial Tracheostomy

吳孟蓉(Meng-Jung Wu)；黃雅鈴(Ya-Ling Huang)

深頸部感染 ； 氣切 ； 言詞溝通障礙 ； Deep Neck Infection ； Tracheostomy ； Impaired verbal communication

若瑟醫護雜誌

14卷1期（2020 / 07 / 01）

47 - 58

繁體中文

深頸部感染病人氣切手術常以緊急和非預期方式出現，本文描述一位65歲女性因深頸部感染執行緊急氣切手術面臨身體失能和心理衝擊。照護期間自2016年9月8日至2016年9月16日，運用Gordon十一項功能性健康型態以觀察、筆談、身體評估、病歷查閱等方式收集資料，確立其健康問題為「呼吸道清除功能失效」、「言詞溝通障礙」和「身體心像紊亂」，護理措施包括有效咳嗽、高頻胸壁震盪治療和抽痰，結合跨領域團隊（醫師、呼吸治療師和復健師）；其次設計溝通圖卡表達其生理需求，建立非語言溝通模式；最後釐清對氣切錯誤認知，運用鏡子了解和接受身體結構改變，提供多媒體教學（網路影片、衛教單張、回覆示教和筆試），讓個案和家屬共同學習照護和建立自信心，不只個案恢復健康返家，也讓家庭早日回歸正常生活，臨床氣切手術著重術前評估和風險管理，缺乏術後照護流程，期望藉此分享照護經驗，以提供醫院建立標準作業規範，提供全面和高品質照護。

A tracheostomy for patients with a deep neck infection often takes place in an urgent and unexpected manner. This paper describes a 65-year-old woman with respiratory compression due to a deep neck infection, and the physical dysfunction and mental impact experienced after emergency tracheostomy was performed. The nursing care period was from September 8th to September 16th, 2016. The Gordon’s 11 functional patterns as the assessment framework through observations, written communication, physical assessments, medical record review, etc., data was collected. The main health problems include Ineffective airway clearance, impaired verbal communication, and disturbed body image. The nursing care measures include: impart effective cough, high-frequency chest wall oscillation treatment and sputum suction. The cross-disciplinary teams (physicians, respiratory therapists, and rehabilitation workers) worked together to restore the case's health as soon as possible. Secondly, communication flash cards (including human figures and texts) were designed. Using simple techniques, the physiological needs were expressed, and a non-verbal communication mode was established. Finally, the case was encouraged to express her feelings towards the tracheostomy in order to clarify misconceptions about tracheostomy. A mirror was used for her to understand and accept the changes in body structure, while multimedia teaching methods including online videos, health education leaflets, reply teaching and written tests were provided to enable the case and her family members to jointly learn about tracheostomy wound care and rebuild self-confidence, so as to not only restore the case's health to be discharged and return home, but also ensure the family returns to normal life as soon as possible. Tracheostomy care at present focuses on pre-operative assessment and risk management, but lacks post-operative care procedures. Therefore it is hoped that the experience of nursing care will be shared to recommend the hospitals should establish standard operating procedures to provide comprehensive high-quality care.

1. 王霰邡,黃久美,李詩敏,楊馥綺(2016)。「看」病：病人如何表述自己的疾病－疾病表述常識模式(CSM-IR) 的應用。長庚護理，27(3)，334-341。
   連結：
2. 賴美玉,陳玉如,游顯妹(2015)。接受氣切病人生活品質改變及主要照顧者認知感受之初探。源遠護理，9(3)，27-36。
   連結：
3. Barber, BR,Dziegielewski, PT,Biron, VL,Ma, A,Seikaly, H(2014).Factors associated with severe deep neck space infections: targeting multiple fronts.Journal of Otolaryngology-Head and Neck Surgery,43(1),35.
4. Borthwick, S(2012).Communication impairment in patients following stroke.Nursing Standard,2(19),5-41.
5. Freysteinson, WM(2012).Use of mirrors as a nursing intervention to promote patients' acceptance of a new body image.Clinical Journal of Oncology Nursing,16(5),533-536.
6. McDonald, J,McKinlay, E,Keeling, S,Levack, W(2016).Becoming an expert carer : the process of family carers learning to manage technical health procedures at home.Journal of Advanced Nursing,72(9),73-2184.
7. Voelker, MT,Wiechmann, M,Dietz, A,Laudi, S,Bercker, S(2017).Two-Year Follow-Up After Percutaneous Dilatational Tracheostomy in a Surgical ICU.Respiratory Care,62(7),963-969.
8. 吳國湘,蕭自佑,古世基,陳佳慧(2014)。長期經口氣管插管在口腔、咽、喉及氣管之合併症。台灣醫學，18(5)，580-584。
9. 張旭良,楊志仁,洪仁宇,洪加芬,蘇育正,鍾飲文(2013)。經皮氣管切開術在加護病房重症患者的運用。內科學誌，24(3)，153-161。
10. 陳慧秦,王秀紅(2014)。氣切照護管理運用在呼吸器依賴病人的文獻評析。長庚科技學刊，21，25-38。
11. 趙麗玫,游金靖(2017)。探討高頻胸壁振盪治療對患者痰液清除之成效。澄清醫護管理雜誌，13(4)，44-54。
12. 盧采臻,王雅慧(2014)。氣切病人接受語言治療現況之初探。台灣復健醫學雜誌，42(2)，99-110。

1. 葉美杞,王維敏(2023)。運用跨團隊模式協助一位下咽癌患者面對死亡恐懼之照護經驗。領導護理，24(2)，130-144。