一位初次診斷愛滋病併發肺囊蟲肺炎病人之照護經驗

Nursing Experience for a Patient with Initial Diagnosis of Acquired Immunodeficiency Syndrome Complicated with Pneumocystis Pneumonia

蔡惠雯(Hui-Wen Tsai)；趙家伶(Chia-Ling Chao)

愛滋病 ； 肺囊蟲肺炎 ； 氣體交換障礙 ； 決策衝突 ； 預期性哀傷 ； AIDS ； pneumocystis pneumonia ； gas exchange disorder ； medical decisional conflict ； anticipatory grief

若瑟醫護雜誌

17卷1期（2023 / 06 / 01）

70 - 80

繁體中文;英文

本文探討一位愛滋病併發肺囊蟲肺炎病人之照護經驗。照護期間為2019/10/17至2019/10/26，藉由身體評估、觀察、病歷查閱、會談等方法收集資料，運用生理、心理、社會發展、靈性層面進行護理評估，確立個案主要健康問題有氣體交換障礙、決策衝突、預期性哀傷。個案因肺囊蟲肺炎導致呼吸衰竭，且對醫療決策猶豫不定，再加上病程急速惡化導致生命受到威脅，引發上述健康問題，醫療團隊透過監測呼吸型態及血氧變化，適時調整給氧方式及藥物治療，運用噘嘴式呼吸控制呼吸速率及深度，促進肺擴張並維持血氧；透過不帶偏見、同理的態度協助釐清疑問，開立家庭會議說明治療優缺點，最終達到共識；鼓勵病人表達對死亡的感受，適時給予關心與支持，引導生命回顧完成心願，此照護經驗成為撰筆分享之動機。建議醫療團隊應及時照會安寧團隊以提供「非癌症」之安寧療護計畫，捍衛每個人生命末期時的舒適與尊嚴，期望此護理經驗能提供爾後照護此類病人之參考。

This article discusses the nursing experience of a patient with AIDS complicated by Pneumocystis pneumonia. The nursing period is from 2019/10/17 to 2019/10/26. Data is collected through physical assessment, observation, medical record review, interviews, etc., and nursing assessment is carried out on the basis of physical, psychological, social development, and spirituality, and the main health problems of the case are identified. There are gas exchange disorders, decisional conflicts, anticipatory grief. The patient suffered from respiratory failure and discomfort due to Pneumocystis pneumonia, and was hesitant to make medical decisions. In addition, the rapid deterioration of the disease course led to life-threatening problems, which caused the above-mentioned health problems. The medical team monitors breathing patterns and changes in blood oxygen, and adjusts oxygen supply and drug therapy. Pout-style breathing is used to control breathing rate and depth, promote lung expansion and maintain blood oxygen; help clarify doubts through an unbiased and empathetic attitude, hold family meetings to explain the advantages and disadvantages of treatment, and finally reach a consensus; encourage patients to express The feelings of death, timely care and support, and guide the life to review and fulfill the wish. This care experience has become the motivation for writing and sharing. It is suggested that the medical team should promptly notify the hospice team to provide a "non-cancer" palliative care plan to safeguard everyone's comfort and dignity at the end of life. It is hoped that this nursing experience can provide a reference for the care of such patients in the future.

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