重度失智併呼吸衰竭個案之護理經驗

Nursing Experience of Caring for Severe Dementia with Respiratory Failure

林桂鈴(Kuei-Ling Lin)；鍾怡珣(Yi-Hsun Zhong)；盧玉華(Yu-Hua Lu)

失智症 ； 呼吸衰竭 ； 睡眠型態紊亂 ； 照顧者角色緊張 ； dementia ； respiratory failure ； disrupted sleep pattern ； caregiver role strains

若瑟醫護雜誌

18卷1期（2024 / 06 / 01）

87 - 98

繁體中文;英文

本文探討一位重度失智併呼吸衰竭個案之護理經驗。護理期間為2022年3月15日至2022年4月30日，我們運用觀察、身體評估、會談、Gordon十一項健康功能型態評估等方式收集資料，經評估分析後，進一步確定個案有呼吸道清除功能失效、睡眠型態紊亂及案妻有照顧者角色緊張之護理問題。在照護期間我們與案妻共同討論照護計畫及目標，透過胸腔物理治療及胸腔復健運動改善痰液排除問題，藉由增加白天活動量、穴位按摩及夜間採集中照護改善睡眠紊亂問題；透過全人照護方式，安排跨團隊會議，提供疾病進展與未來治療之方向，並請案妻共同參與學習管路照護技巧及提供支持團體資源資訊，減輕案妻對個案疾病所帶來衝擊。期望此護理經驗，提供臨床照顧此類病人參考。

This study explored caregiver role strains of severe dementia with respiratory failure during the pandemic. The caregiving period extended from March 15, 2022, to April 30, 2022. To gather data for this case report, we utilized observation, physical assessments, interviews, and Gordon's 11 functional health patterns. Following our clinical evaluation and analysis, we confirmed the presence of ineffective airway clearance, disrupted sleep patterns in the patient, and caregiver role strain. We collaborated with the patient's wife to discuss a care plan and set objectives for improving the patient's condition. This involved enhancing sputum removal through chest physical therapy and chest rehabilitation exercises, as well as improving the patient's sleep quality through increased daytime activity, acupressure, and centralized care management during night shifts. Embracing a holistic healthcare approach, we arranged interprofessional collaborative meetings, provided information on disease progression and future treatment guidelines, and invited the patient's wife to acquire tube care skills. Additionally, we offered support group resource information to mitigate the impact of the patient's condition on his wife. We hope that this nursing experience and the reference materials can be shared among clinical nursing staff caring for similar cases.