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護(hù)患情境會(huì)話

哮喘急性發(fā)作患兒的護(hù)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(zhǎng)由于對(duì)疾病缺乏認(rèn)識(shí)，感到緊張。護(hù)士小姜來(lái)到床邊進(jìn)行護(hù)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(hù)士：沈敏，你剛才做了氧噴感覺(jué)舒服一點(diǎn)了嗎？

患兒：阿姨，我難受(哭)。

護(hù)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(huì)增加耗氧量，你就更不舒服了。聽(tīng)話，阿姨最喜歡你了，好好睡一覺(jué)，好嗎？

患兒家長(zhǎng)：已經(jīng)用了這么多藥了，怎么還喘啊?

護(hù)士：剛才我們用的是支氣管擴(kuò)張劑，可以解除支氣管痙攣。過(guò)一會(huì)兒您的孩子會(huì)感覺(jué)舒服一點(diǎn)的。喘息也會(huì)慢慢緩解。

患兒：阿姨，我還是難受，不想睡覺(jué)。

護(hù)士：阿姨去請(qǐng)醫(yī)生來(lái)看你，好嗎？

(醫(yī)生檢查后給予鎮(zhèn)靜劑和吸氧)

護(hù)士：阿姨給你吸點(diǎn)氧氣，再在屁股打一點(diǎn)睡覺(jué)的藥。這能幫助你好好睡一覺(jué)，醒來(lái)的時(shí)候你會(huì)感覺(jué)舒服多了。

患兒家長(zhǎng)：打睡覺(jué)針會(huì)有什么副作用嗎？

護(hù)士：現(xiàn)在患兒煩躁，容易使支氣管痙攣，加重呼吸困難。給她鎮(zhèn)靜劑后，可以降低耗氧量，改善缺氧癥狀。

患兒家長(zhǎng)：我孩子總是要發(fā)哮喘，這次一定要給我們治好。

護(hù)士：哮喘治療是一個(gè)長(zhǎng)期的過(guò)程，也需要你們家長(zhǎng)積極配合。要保持空氣新鮮流通，避免容易引起過(guò)敏的物品及刺激性氣味。加強(qiáng)營(yíng)養(yǎng)，但應(yīng)避免誘發(fā)哮喘的食物，如魚(yú)、蝦、牛奶等。等你孩子病好一點(diǎn)還要繼續(xù)用藥，到時(shí)我們會(huì)詳細(xì)給您講解的。您有什么疑問(wèn)也可以直接問(wèn)我。我過(guò)一會(huì)兒再來(lái)。您有什么事請(qǐng)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)