一位慢性阻塞肺病重症個案肺部復健之案例報告

Abstract

本文探討一位罹患慢性阻塞肺病,首次因急性呼吸衰竭,放置氣管內管入住加 護病房之護理經驗,於 2017/12/18 至 2018/01/20 護理期間,以直接照護、觀察、 身體評估與家屬會談及病歷查閱等方式蒐集資料。運用羅氏適應模式進行整體性系 統評估,確立護理問題有:呼吸道清除功能失效、活動無耐力及家庭因應能力失 調。照護過程中,透過良好護病關係的建立,提供照護措施,在呼吸道清除功能失 效方面:教導正確呼吸且有效的咳嗽技巧及胸腔物理治療,以利清除痰液;在活動 無耐力方面:偕同跨領域團隊與個案及家屬規劃肺部復健運動,增強呼吸肌耐力, 順利拔除氣管內管;在家庭因應能力失調方面 : 安排家庭會議,增加家人間對後續返 家的共識及照護,增強其家庭因應能力。建議運用跨團隊合作建立一套國台語雙聲 帶的肺部復健運動多媒體影音光碟,在急重症等重負荷的工作下,短時有效的指導 此類個案,又能提升個案之學習成效,因此改善呼吸道症狀與減少急性發作次數及 再住院率,得以減輕家庭負擔,藉此照護經驗分享,以供臨床實務參考之用。  This paper aims to explore the nursing experience for a patient with chronic obstructive pulmonary disease who was hospitalized in an intensive care unit for the first time because of acute respiratory failure requiring endotracheal tube intubation. The data were collected through direct nursing care, observations,physical evaluations, interviews and reviews of medical record during the nursing period from December 18 2017 to January 20 2018. Roy’s adaptation model was applied to carry out comprehensive system assessments. The problems observed from the nursing process were as follows: ineffective airway clearance, activity intolerance and family adjustment disorders. During the nursing processes, good relationships were established between medical staff and the patient in order to provide necessary nursing measures. Regarding ineffective airway clearance, the patient was taught to breath in an appropriate way, effective coughing techniques and chest physical therapy for better sputum clearance. As to activity intolerance, an inter-professional collaborative team was invited to work with the patient and the family for planning pulmonary rehabilitation exercises in order to strengthen respiratory muscle endurance followed by smoothly removing the endotracheal tube. When it comes to improving family adjustment disorders, meetings with the family were arranged to enhance the family’s consensus and nursing skills for the patient after returning home. It is suggested that an inter-professional team can work together to produce a set of multimedia DVDs both in Chinese and Taiwan- ese to provide guidance on pulmonary rehabilitation exercise. This set of DVDs can help effectively instruct patients like this case for the short-term when there are heavy workloads from acute and severe diseases and then increase patients’learning results. Therefore, respiratory tract symptoms can be improved and the numbers of acute attacks and readmission rates can be reduced. After these steps, the burdens imposed on families can be relieved accordingly. This nursingexperi- ence is hereby shared and serves as a reference for clinical practices.