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題名:一位急性呼吸窘迫症候群病患採俯臥治療的護理經驗
書刊名:長庚護理
作者:賴惠玲黃敏瑢周晉伊
作者(外文):Lai, Hui-lingHuang, Min-jungChou, Chin-yi
出版日期:2014
卷期:25:4=88
頁次:頁480-490
主題關鍵詞:急性呼吸窘迫症候群俯臥無望感Acute respiratory distress syndromeProne-positioningHopelessness
原始連結:連回原系統網址new window
相關次數:
  • 被引用次數被引用次數:期刊(2) 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:2
  • 共同引用共同引用:26
  • 點閱點閱:129
本文描述一位62歲女性因呼吸衰竭併發急性呼吸窘迫症候群,病患面臨換氣不足感受瀕臨死亡的威脅而產生負面情緒,醫療團隊運用俯臥治療改善病患氧合之護理經驗。照護期間為2012年11月14日至2012年11月26日,以Gordon十一項功能性健康型態進行整體評估,藉直接護理、觀察、身體評估,使用紙筆、圖卡與病患會談的方式收集資料,確立病患有氣體交換功能障礙、呼吸道清除功能失效、潛在性皮膚完整性受損、無望感等護理問題。在護理過程中筆者提供個別性的護理措施,藉俯臥姿勢改善氧合狀態,監測血氧變化,進而維持足夠換氣,增進其信心及希望,並在病患無法清除痰液時,協助抽痰、維持呼吸道的通暢,當病患俯臥時使用水球及軟墊於骨突處避免壓瘡產生,且應用言語上的鼓勵、關懷和家屬支持等方法,增進病患的心理安適,讓病患能渡過這漫長的治療過程。在醫療團隊共同努力下,病患成功脫離呼吸器轉至胸腔內科病房,期望能藉由此照護經驗,做為未來照護相關病患的參考。
This article described the nursing experience of caring a 62-year-old woman with acute respiratory distress syndrome due to respiratory failure. She faced hypoventilation and threat of near-death experience that produced negative emotions. The author applied the nursing experience of prone-position therapy to improve oxygenation. Nursing Care was from November 14 to 26, 2012. Gordon 11 Functional Health Pattern was used to assess the patient’s health status. Data was collected through observation, direct care, and physical assessment, using writing, figure cards, and communication. The nursing care problems included impaired gas exchange, ineffective airway clearance, potential for impaired skin integrity, a sense of hopelessness. The authors provided individualized nursing care plans, including improving oxygenation in prone-position therapy, monitoring oxygen exchange, maintaining adequate ventilation, and enhancing confidence and hope. When the patient could not expectorate sputum by herself, assistance was provided to facilitate suction and maintain free airway flowing. To prevent pressure ulceration, water polo and cushion under bony prominences were provided. The patient was encouraged by nursing staffs and family support to receive the long-term treatment. The healthcare team helped the patient wean ventilator, thus transferred to chest medical ward.
期刊論文
1.鍾卉庭、徐玲蕙、潘昭君、楊淑燕、陳婉宜(20110600)。降低外科加護病房病人壓瘡發生率之專案。護理雜誌.附冊,58(3),56-63。new window  延伸查詢new window
2.游群翔、陳炯睿(20120200)。俯臥通氣與急性呼吸窘迫症候群。內科學誌,23(1),1-8。  延伸查詢new window
3.Ranieri, V. M.、Rubenfeld, Gordon D.、Thompson, B. T.、Ferguson, N. D.、Caldwell, E.、Fan, E.、Pesenti, A.(2012)。Acute respiratory distress syndrome: the Berlin definition。The Journal of the American Medical Association,307(23),2526-2533。  new window
4.曲長科、陳昌文(20090600)。急性呼吸窘迫症候群病患之呼吸器吐氣末陽壓及潮氣容積之設定--一個持續爭論的議題。內科學誌,20(3),197-202。  延伸查詢new window
5.李玉嬋(20080500)。常用的醫病溝通技巧。諮商與輔導,269,51-58。  延伸查詢new window
6.Blanch, L.、Murias, G.(2012)。Back to the bench: Inhaled iloprost and prone positioning in ARDS。Minerva Anestesiologica,78(9),979-981。  new window
7.Chen, C. H.、Yen, H. M.(2009)。Adult onset Still’s disease with initial manifestations mimicking pneumonia with pleural effusion--A case report。Thoracic Medicine,24(2),106-110。  new window
8.Dirkes, S.、Dickinson, S.、Havery, R.、O'brien, D.(2012)。Prone positioning is it safe and effective?。Critical Care of Nursing Quarterly,35(1),64-75。  new window
9.Pierrakos, C.、Karanikolas, M.、Scolletta, S.、Karamouzos, V.、Velissaris, D.(2011)。Acute respiratory distress syndrome: Pathophysiology and therapeutic options。Journal of Clinical Medicine Research,4(1),7-16。  new window
10.蘇清菁、陳玉敏(20091200)。無望感之概念分析。長庚護理,20(4)=68,456-462。new window  延伸查詢new window
圖書論文
1.陳夏蓮、葉明珍(2012)。呼吸系統疾病病人之護理。內外科護理學。台北市:華杏。  延伸查詢new window
 
 
 
 
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