護患情境會話

?

護患情境會話

哮喘急性發作患兒的護理

Nursing Care for a Child with an Acute Asthma Attack

背景

患兒沈敏，女，6歲，因“咳喘一天”而入院?；純阂蚝粑щy感到恐懼、緊張,比較煩躁，大汗淋漓。家長由于對疾病缺乏認識，感到緊張。護士小姜來到床邊進行護理。

Background

Shen Min, a 6 year old girl, was admitted to the hospital because of coughing and wheezing for one day. Because of difficulty in breathing, the child was scared, nervous, restless, and perspired heavily. Her parents were also nervous due to their lacking knowledge about the disease. Nurse Jiang came to her bedside to care for her.

交流

護士：沈敏，你剛才做了氧噴感覺舒服一點了嗎？

患兒：阿姨，我難受(哭)。

護士：(給孩子靠在床頭半臥位)沈敏，你是大孩子了，乖，不要哭了，哭了會增加耗氧量，你就更不舒服了。聽話，阿姨最喜歡你了，好好睡一覺，好嗎？

患兒家長：已經用了這么多藥了，怎么還喘啊?

護士：剛才我們用的是支氣管擴張劑，可以解除支氣管痙攣。過一會兒您的孩子會感覺舒服一點的。喘息也會慢慢緩解。

患兒：阿姨，我還是難受，不想睡覺。

護士：阿姨去請醫生來看你，好嗎？

(醫生檢查后給予鎮靜劑和吸氧)

護士：阿姨給你吸點氧氣，再在屁股打一點睡覺的藥。這能幫助你好好睡一覺，醒來的時候你會感覺舒服多了。

患兒家長：打睡覺針會有什么副作用嗎？

護士：現在患兒煩躁，容易使支氣管痙攣，加重呼吸困難。給她鎮靜劑后，可以降低耗氧量，改善缺氧癥狀。

患兒家長：我孩子總是要發哮喘，這次一定要給我們治好。

護士：哮喘治療是一個長期的過程，也需要你們家長積極配合。要保持空氣新鮮流通，避免容易引起過敏的物品及刺激性氣味。加強營養，但應避免誘發哮喘的食物，如魚、蝦、牛奶等。等你孩子病好一點還要繼續用藥，到時我們會詳細給您講解的。您有什么疑問也可以直接問我。我過一會兒再來。您有什么事請按鈴。

Interactions

Nurse: Shen Min, do you feel better after being nebulized?

Patient Child: Auntie nurse, I feel bad (crying).

Nurse: (putting the girl into a semi-reclining position) Shen Min, you are a big girl now. Don’t cry any more. Crying will increase the oxygen consumption which will make you feel even worse. I love you very much. Have a good rest, OK?

Patient’s Parent: She has taken so many medicines, why is she still wheezing?

Nurse: We just gave her a bronchodilator. It will relieve the bronchial spasm. Your child will feel better after awhile, and the wheezing will be relieved too.

Patient Child: Auntie nurse, I still feel bad, and don’t want to sleep.

Nurse: I will call for a doctor, OK?

(After examination, the doctor asked the nurse to give the patient a sedative and oxygen inhalation.)

Nurse: I will let you inhale some oxygen, and give you a sedative drug via intramuscular injection on your buttock. This will help you sleep and you will feel much better when you wake up.Patient’s Parent: Does the sedative have any side effects?

Nurse: Your child is restlessness now and will cause bronchial spasms more easily. This will aggravate the breathing problem. Giving her a sedative will decrease the oxygen consumption and improve her hypoxia.

Patient’s Parent: My child often has acute attacks. You should cure her completely this time.

Nurse: The treatment of asthma is a long term process. It needs the parents’ cooperation. You should keep fresh air circulating in your home, avoid allergens and irritating odors, improve her nutrition, and avoid foods which may induce asthma attack, such as fish, shrimp, milk, and so on. She needs to continue take the medicine even after she feels better. We’ll tell you the details at that time. If you have any questions, you may ask me. I will come back shortly. You may press the call button if there is something urgent.

(湯文決)