护患情境会话



护患情境会话

哮喘急性发作患儿的护理

Nursing Care for a Child with an Acute Asthma Attack

背景

患儿沈敏，女，6岁，因“咳喘一天”而入院。患儿因呼吸困难感到恐惧、紧张,比较烦躁，大汗淋漓。家长由于对疾病缺乏认识，感到紧张。护士小姜来到床边进行护理。

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

护士：沈敏，你刚才做了氧喷感觉舒服一点了吗？

患儿：阿姨，我难受(哭)。

护士：(给孩子靠在床头半卧位)沈敏，你是大孩子了，乖，不要哭了，哭了会增加耗氧量，你就更不舒服了。听话，阿姨最喜欢你了，好好睡一觉，好吗？

患儿家长：已经用了这么多药了，怎么还喘啊?

护士：刚才我们用的是支气管扩张剂，可以解除支气管痉挛。过一会儿您的孩子会感觉舒服一点的。喘息也会慢慢缓解。

患儿：阿姨，我还是难受，不想睡觉。

护士：阿姨去请医生来看你，好吗？

(医生检查后给予镇静剂和吸氧)

护士：阿姨给你吸点氧气，再在屁股打一点睡觉的药。这能帮助你好好睡一觉，醒来的时候你会感觉舒服多了。

患儿家长：打睡觉针会有什么副作用吗？

护士：现在患儿烦躁，容易使支气管痉挛，加重呼吸困难。给她镇静剂后，可以降低耗氧量，改善缺氧症状。

患儿家长：我孩子总是要发哮喘，这次一定要给我们治好。

护士：哮喘治疗是一个长期的过程，也需要你们家长积极配合。要保持空气新鲜流通，避免容易引起过敏的物品及刺激性气味。加强营养，但应避免诱发哮喘的食物，如鱼、虾、牛奶等。等你孩子病好一点还要继续用药，到时我们会详细给您讲解的。您有什么疑问也可以直接问我。我过一会儿再来。您有什么事请按铃。

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.

(汤文决)