郁血性心脏病患者出院前2周及返家一个月之呼吸照护课件.ppt

1、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 pleural effusion(C-P angle blunting)、infiltr

2、ation 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 adults inflation lung to 40cmH2O,maintain more

3、 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 thin wall high volumeLow pressure cuff in the Tr.Wh

4、en 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 home nocturnal support 3週進步最大項目為移位功能移位功能出院前 居家二週後健康生活品質評估