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題名:運用Levine保存模式照護一位敗血症個案之護理經驗
書刊名:護理雜誌
作者:張寧郁賴亭伃劉雅菁黃翠媛 引用關係
作者(外文):Chang, Ning-yuLai, Ting-yuLiu, Ya-jingHuang, Tsuey-yuan
出版日期:2013
卷期:60:2
頁次:頁103-110
主題關鍵詞:敗血症保存模式敗血症照護SepsisLevine's conservation modelSepsis care
原始連結:連回原系統網址new window
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  • 被引用次數被引用次數:期刊(0) 博士論文(0) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:0
  • 共同引用共同引用:4
  • 點閱點閱:204
敗血症是因感染而引起的全身性發炎反應,病程進展快速,影響全身器官功能,進而造成個體生命威脅。目前以實證基礎之敗血症組合照護(sepsis bundles),配合強調整體性評估及全人照護之護理模式,應可改善敗血症病人照護成效。筆者利用Levine保存模式照護一位敗血症個案,照護期間自2011年6月10日至2011年7月5日,透過身體評估、病歷查閱、病人筆談、家屬及訪客會談與觀察方式收集相關資料,並根據保存模式進行護理評估,發現個案無法成功調適其能量、結構、個人完整及社會完整性等四個保存原則。護理過程中,藉由提供敗血症組合照護模式及初步復甦措施,協助個案獲得能量的保存;以感染的預防,維持其結構的完整;維護自尊、隱私與維持家庭及社會活動,保存其個人及社會功能的完整,最後成功調適因敗血症造成的整體性失衡。期望此保存模式運用的照護經驗分享,可提供護理人員日後於臨床照護敗血症個案之參考。
Sepsis is a systemic inflammation caused by severe infection. It is a condition that is life-threatening, progresses rapidly, and affects multiple system functions. An evidence-based medical sepsis bundles model has been used for sepsis care in clinic practice. Therefore, a holistic nursing care protocol for patients with sepsis is needed to improve medical outcomes. This case study describes a nursing experience using Levine's Conservation Model to care for a patient with sepsis. Data were collected using physical assessment, medical chart reviews, written communications with the patient, interviews patient family members, and observing the patient during intensive care hospitalization from June 10th, 2011 through July 5th, 2011. Levin's Conservation Model, used as the nursing guideline, successfully identified patient issues including failure to conserve energy, structural, personal and social integrity. Interventions included: (1) sepsis bundles and early goal directed therapy to reduce patient energy expenditure; (2) prevention of infection to maintain structural function; and (3) enhancement of self-esteem, privacy, family cohesion, and social activities to maintaining personal and social integrity functions. The interventions helped the case adapt successfully to the sepsis-related imbalance. This case report provides a valuable nursing care experience as a reference for similar sepsis cases in the future.
期刊論文
1.王義明、黃煜為、林姿伶、陳思穎(20090800)。重症病患的營養支持。中華民國重症醫學雜誌,10(3),229-241。  延伸查詢new window
2.邱艷芬(20100200)。休克之生理監測與臨床評估。護理雜誌,57(1),5-10。new window  延伸查詢new window
3.林世斌、黃英哲(2009)。008年戰勝敗血症指引--初始復甦(initial resuscitation),決戰黃金六小時。中華民國重症醫學雜誌,10(1),8-11。  延伸查詢new window
4.傅彬貴、李博仁(20110400)。急重症患者及敗血症患者之血糖控制--一個持續爭論的議題。內科學誌,22(2),121-132。  延伸查詢new window
5.黃國巡、胡美華、洪楠凱、蔡建松、劉天健、廖文進(20100200)。休克之臨床治療現況與趨勢。護理雜誌,57(1),11-16。new window  延伸查詢new window
6.潘雪幸、張慕民、蕭存芳、張秉宜、吳品萱(20080900)。加護病房病人之壓力源及其護理。長庚護理,19(3)=63,353-359。new window  延伸查詢new window
7.Aitken, L. M.、Williams, G.、Harvey, M.、Blot, S.、Kleinpell, R.、Labeau, S.、Ahrens, T.(2011)。Nursing considerations to complement the surviving sepsis campaign guidelines。Critical Care Medicine,39(7),1800-1818。  new window
8.Dellinger, R. P.、Levy, M. M.、Carlet, J. M.、Bion, J.、Parker, M. M.、Jaeschke, R.、Vincent, J. L.(2008)。Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock: 2008。Critical Care Medicine,36(1),296-327。  new window
9.Dellinger, R. P.、Levy, M. M.、Carlet, J. M.、Bion, J.、Parker, M. M.、Jaeschke, R.、Vincent, J. L.(2008)。Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock: 2008。Intensive Care Medicine,34(1),17-60。  new window
10.De Miguel-Yanes, J. M.、Munoz-Gonzalez, J.、Andueza-Lillo, J. A.、Moyano-Villaseca, B.、Gonzalez-Ramallo, V. J.、Bustamante-Fermosel, A.(2009)。Implementation of a bundle of actions to improve adherence to the Surviving Sepsis Campaign guidelines at the ED。The American Journal of Emergency Medicine,27(6),668-674。  new window
11.Levine, M. E.(1996)。The conservation principles: A retrospective。Nursing Science Quarterly,9(1),38-41。  new window
12.Rivers, E.、Nguyen, B.、Havstad, S.、Ressler, J.、Muzzin, A.、Knoblich, B.、Tomlanovich, M.(2001)。Early goal-directed therapy in the treatment of severe sepsis and septic shock。The New England Journal of Medicine,345(19),1368-1377。  new window
圖書
1.杜友蘭(2008)。護理理論與實務運用。台北市:華杏。  延伸查詢new window
2.Levine, M. E.(1973)。Introduction to clinical nursing。Philadelphia, PA:F. A. Davis.。  new window
3.Meleis, A. I.(2007)。Theoretical nursing: Development and progress。Philadelphia, PA:New York:Lippincott Williams & Wikins。  new window
其他
1.行政院衛生署(201109)。100年度十大死因統記,http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_ fod_list_no=12336&class_no=440&level_no=4。  new window
2.Surviving Sepsis Campaign.(201112)。About the campaign,http://www.survivingsepsis.org/Pages/default.aspx。  new window
 
 
 
 
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