理經驗前言 用持續性幫浦餵食一位腹壁裂合併低出生體重兒之護理經驗TZU CHI NURSING JOURNAL Volume 12. Number 6. December 2013 第十二卷第六期運中文摘要 理經驗 1~5/10,000 (Benjamin, Ethen, Van Hook, Myers, & Canfield, 2010) 許惠昭黃小萍 * 許惠玲 ** 陳宜綸 *** 2011 5 5 2011 5 29Gordon : ; ; ( 2013; 12:6, 108-117) 關鍵詞 : 腹壁裂 持續性幫浦餵食 低出生體重兒 90% (Fillingham & Rankin, 2008) 1/3 2/3(Netta et al., 2007) 長庚醫院高雄院區新生兒加護病房護理師長庚醫院高雄院區新生兒加護病房護理長 * 長庚醫院高雄院區新生兒加護病房副護理長 ** 高雄長庚紀念醫院新生兒科主治醫師 *** 接受刊載 :2012 年 11 月 21 日通訊作者地址 : 許惠昭 83301 長庚醫院高雄院區新生兒加護病房高雄市鳥松區大埤路 123 號電話 :886-7-731-7123 轉 8515 電子信箱 :chang.a0131@msa.hinet.net 貳 文獻查證 一 腹壁裂合併低出生體重 1/3~2/3 (Netta et al., 2007) 2-3 二 腹壁裂之餵食方式 Newborn Individualized Care and Assessment Program (NIDCAP) (Dsilna, Christensson, Gustafsson, Lagercrantz, & Alfredsson, 2008) (Dsilna, Christensson, Alfredsson, Lagercrantz, & Blennow, 2005) 三 新生兒疼痛評估及控制 (Batton, Barrington, & Wallman, 2006) 2008 Hummel Neonatal Pain, Agitation and Sedation Scale (N-PASS) 30 (Hummel, Puchalski, Creech, & Weiss, 2008) Eutectic Mixture of Local Anesthetics(EMLA) morphine demoral 108 109
用持續性幫浦餵食一位腹壁裂合併低出生體重兒之護理經驗TZU CHI NURSING JOURNAL Volume 12. Number 6. December 2013 第十二卷第六期運 理經驗 ( (2009) 55 50 55 53 2006) (Johnston et al., 2003) 二 家庭簡介及家庭樹 2827 30 26 23 四 嬰兒住院對父母心理壓力調適 7 8 28 27 (Franklin, 2006) (2007) (2006) 一 個案簡介 護理評估 361,930 G1P1 23 25 三 住院過程 2011 5 5 圖一家庭樹 2011 5 52011 5 29 3.0X-ray 5 5 50-70 /145-170 /69/35mmHg/ 28.5 /29.8 Ampicillin Gentamycin Metronidazole 6 表一嬰兒疼痛評估量表 2011 5 5 Apgar score 58 3 / -2-1 0/0 1 2 7 2440Dopamine GetamycinCefotaxime 8Meperidne 2mg iv stat 9 35%35 10 5 15 / 29.2/31 xlactobacillus Mosapride 16 3/ 29.5/31.2 Glycerine for enema 17 Glycerine for enema : <10% Hummel, P., Puchalski, M., Creech, S. D., & Weiss, M. G., 2008, p. 55-60 >10%-20% 76-85% >20% <75% 18 80.9%Nacl 5 19 / 28.8/30.52 5 2 20 25 1 22 3727 1 23 210 1 24 212 1 25 215 1 26 / 28.7/3033585 360 110 111
用持續性幫浦餵食一位腹壁裂合併低出生體重兒之護理經驗TZU CHI NURSING JOURNAL Volume 12. Number 6. December 2013 第十二卷第六期運理經驗四 護理過程 Glycerine for enema 5 188 Gordon 0.9%Nacl 5 5 19 3 / ( 九 ) 性生殖型態 ( 十一 ) 價值信念型態 - 以家庭為評估對象 ( 四 ) 活動運動型態 ( 一 ) 健康認知及處理型態 36.5~37 126~168 / 1,930 2,100 ( 十 ) 應對壓力耐受型態 - 以家庭為評估對象 問題確立與護理計畫 ( 二 ) 營養代謝型態 ( 五 ) 睡眠休息型態 3 ( )( ) 31.5~32.5 ( ) - 1,930 150 150 1.93 289.55 6 5 19 5 25 2 5 22 15 15 26 335 60 (1 0.67 ) (1 3.5 ) 8 49 /8392 20~25 5 26 2,130 ( 三 ) 排泄型態 8~9 3~5 / 5 55 10 5 16 16 ( 六 ) 自我感受自我概念型態 ( 七 ) 認知與感受 3mm ( 八 ) 角色關係型態 - 以家庭為評估對象 一 營養不均衡少於身體所需 / 禁食 餵食不佳 1.5 5 2. 3. :1,930 9% 2,100 4.5 9 35 5.5 16 3 / 29.5 /31.2 6.5 5 / 28.5 /29.8 5 16 / 29.5 /31.2 1.5 55 22 150kcal/kg/day 2.5 205 26 20 25 1. :10%TPN Intrafat 2. 80~120mg/dl 3. 25 2 25 12~3 215 1 335 85360 4. 5. 6. 7. 8. 9. 10. 11. 1.5 5 5 9 98kcal/kg/ day 5 95 15 118kcal/kg/day 5 205 25 130kcal/kg/ day 5 26 3 353 60 150kcal/kg/day 2.5 205 23 5 232,060 5 26 / 28.7/30 2,130 20~25 112 113
理經驗三 潛在危險性父母 - 嬰兒依附關係改變 / 與個案出生腹壁裂導致父母親調適有關 用持續性幫浦餵食一位腹壁裂合併低出生體重兒之護理經驗TZU CHI NURSING JOURNAL Volume 12. Number 6. December 2013 第十二卷第六期運二 急性疼痛 / 術後傷口疼痛 1.5 5 3 2. 5 5 75~85% 8 3.5 55 10 16/ 1. 2.5 8 30 1.5 55 15 8 2 2.5 15 20/ 1.5 16 2.5 18 討論與結論 1. 2. 8 Meperidne 2mg iv Q8H and stat 3. 4. 5. 6. 7. 8. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 1.5 78 Meperidne 2mg iv stat 5 2.5 10 92~98% 4 3.5 14 2 20 92~98% 1. 5 15 2. 5 20 Gordon 參考文獻 洪佳鈴 尹玓 (2009). 一位罹患自發性腸穿孔早產兒的護理經驗. 長庚護理,20(2), 283-291 侯慧明 (2006). 罹患先天性橫膈膜疝氣新生兒之護理經驗. 榮總護理,23(3),234-241 劉美芳 李慈音 (2006). 早產兒和新生兒之疼痛處置與護理評估. 護理雜誌,53(6), 65-72 蘇美嬌 葉淑惠 鄭瑜芬 蘇紫蘋 (2007). 新生兒加護病房病嬰父母需求之探討. 新台 北護理期刊,10(2),25-36 Ralph, S. S., & Taylor, C. M. (2009). 最新護理診斷手冊 : 護理計畫措施 ( 黃靜微 林家綾 喬佳宜 林麗秋 郭惠敏 程子芸 張秉宜譯 ). 臺北市 : 華杏 ( 原著出版於 2007) Batton, D. G., Barrington, K. J., & Wallman, C. (2006). Prevention and management of pain in the neonate: An update. Pediatrics, 118(5), 2231-2241. Benjamin, B. G., Ethen, M. K., Van Hook, C. L., Myers, C. A., & Canfiield, M. A. (2010). Gastroschisis prevalence in Texas 1999-2003. Birth Defects Resear Part A-Clinical and Molecular Teratology, 88(3), 178-185. Dsilna, A., Christensson, K., Alfredsson, L., Lagercrantz, H., & Blennow, M. (2005). Continuous feeding promotes gastrointestinal tolerance and growth in very low birth weight infants. Journal of Pediatrics, 147(1), 43-49. Dsilna, A., Christensson, K., Gustafsson, A. S., Lagercrantz, H., & Alfredson, L. (2008). Behavioral stress is affected by the mode of tube feeding in very low birth weight infants. Clinical Journal of Pain, 24(5), 447-455. Fillingham, A., & Rankin, J. (2008). Prevalence, prenatal diagnosis and survival of gastroschisis. Prenat Diagn, 28(13), 1232-1237. Franklin, C. (2006). The neonatal nurse s role in parental attachment in the NICU. The Journal of Critical Care Nurse Quarterly, 29(1), 81-85. Hummel, P., Puchalski, M., Creech, S. D., & Weiss, M. G. (2008). Clinical reliability and validity of the N-PASS: Neonatal pain, agitation and sedation scale with prolonged 114 115
用持續性幫浦餵食一位腹壁裂合併低出生體重兒之護理經驗TZU CHI NURSING JOURNAL Volume 12. Number 6. December 2013 第十二卷第六期運pain. Journal of Perinatol, 28(1), 55-60. 理經驗Johnston, C. C., Stevents, B., Pinelli, J., Gibbins, S., Filion, F., Jack, A.,...Steele, S. (2003). Kangaroo care is effective in diminishing pain response in preterm neonates. Archives of Pediatrics & Adolescent Medicine, 157(11), 1084-1088. Natta, D. A., Wilson, R. D., Visintainer, P., Johnson, M. P., Hedrick, H. L., Flake, A. W., & Adzick, N. S. (2007). Gastroschisis: Growth patterns and a pro-posed prenatal surveillance protocol. Fetal Diagnosis Therapy, 22(5), 352-357. 什麼都沒做, 就是空過的人生 ; 若能不斷付出利益人群, 就是大好的人生 ~ 證嚴法師靜思語 ~ If we don t do something meaningful, our life will pass by in vain, but if we work unceasingly for the betterment of mankind, ours will be a beautiful life. ~ Master Cheng Yen ~ A Nursing Experience of Persistent Feeding of a Neonate Suffering from Gastroschisis Complicated with Low Birth Weight ABSTRACT Hui-Chao Hsu, Hsiao-Ping Huang*, Hui-Ling Hsu**, I-Lun Chen*** This study presented a nursing experience of applying a persistent feeding pump on a neonate with gastroschisis and low birth weight. The nursing period lasted from From May 5th to May 29th, 2011. With Gordon 11 Function Health Patterns as framework, we collected and analyzed data through systemic reviewing and direct care. The nursing problems of this case were: 1) nutritional imbalance and deficiency; 2) acute pain; 3)potentially dysfunctional parents. A nursing plan, drafted in accordance to the aforementioned nursing issues to provide an appropriate and individual care, included the following: 1) apply persistent feeding pump, and later replaced with bolus feeding, to accommodate feeding intolerance ensuing gastroschisis repair; 2) apply containment and non-nutritive sucking for acute pain relief; and 3) jointly draft a care plan with the parents and provide associated information as they faced the change in attachment relationship with their child and the pressure of the disease s course, to enhance the parents care technique and restore the child-parent relationship. We hope that this nursing experience could serve as a reference for other nursing staffs when attending to similar to provide appropriate quality care. (Tzu Chi Nursing Journal, 2013; 12:6, 108-117) Keywords: gastroschisis, low birth weight, persistent feeding RN, Kaohsiung Chang Gung Memorial Hospital; Head Nurse, Kaohsiung Chang Gung Memorial Hospital*; Associate Head Nurse, Kaohsiung Chang Gung Memorial Hospital**; Attending Physician, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital*** Accepted: November 21, 2012 Address correspondence to: Hui-Chao Hsu, No.123, Ta-Pei Rd., Niaosong Dist., Kaohsiung City 83301, Taiwan Tel: 886-7-7317123 ext.8515; E-mail: chang.a0131@msa.hinet.net 116 117