郁血性心脏病患者出院前2周及返家一个月之呼吸照护

1、出院前二週準備與出院後一個月的居家協助，可避免病人惡化並延續與建立安全之。入院診斷1.風濕性心臟病(rheumatoid heart disease)、 術後合併分級ii之鬱血性心臟衰竭2.疑似肝功能障礙及嚴重腹水和兩側下肢水腫3.嚴重肺高壓和嚴重三尖瓣閉鎖不全。 病例介紹病例介紹1/20 (上次入院on機 )heart echo： lae rae rve moderate ar sever tr， levf55% rvef:45%，ascites is present)(before nocturnal ventilation)4/13 admissionrml atelectasislt

2、pleural effusion( c-p angle blunting)、infiltration pul edema pul trunk enlargement r/o pul hypertension 過去病史過去病史restrictive lung r/o small airway obstructive身體評估身體評估(首次首次6/24) 視scoliosis 四肢膚色黝黑觸左側chest wall 擴張不全，bil leg pitty edema聽 bil low lobe crackle四肢肌力5分意識狀態清醒巴式量表65分柯式量表2分認知量表(mmse)26分 healthy

3、adults inflation lung to 40cmh2o, maintain more than 7-8s may reexpand all previous collapsed lung tissuerothen hu,et al. 1999轉出icu長照接案lt low lobe atelectasis, start ambu hyperinflationpost ambu 3天後 improvewalking wiith o2and wheelchairassist caregiver education7/10 shiley speaking traininghave a th

4、in wall high volumelow pressure cuff in the tr.when inflated the cuff conforms to the natural shapeof the tr. providing a seal at low intracuff pressure the cuff inflation line has a luer valve with an integral pilot ballon to indicate cuff inflation身體評估7/27下肢水腫已消，顏色轉較白色手顏色轉較白色且四肢回溫7/27 speaking with red buttom, o2nc 2.5lpmambunocturnal 1m2min walking test in room air7/7 start hom