부산대학교 도서관

Purposes: This article describes a patient with heart failure who had a long-term ventilator dependence and was admitted to the respiratory care unit and successfully weaned from ventilator use by progressive breathing training and rehabilitation exercise. The author provided care from December 23, 2016 to May 2, 2017. By using Gordon's 11-item functional health pattern assessment and collecting data by observation, companionship, listening, physical assessment, and so on, the following main problems in nursing were identified: dysfunctional ventilatory weaning response/insufficient expectoration ability and respiratory muscle strength, lack of activity tolerance/reduced cardiac output, lack of knowledge for the care of the tracheostomy speaking valve/health problems related to poor accessibility to information, and anxiety/concern about weaning failure. Expectoration ability was enhanced through abdominal muscle training by deep breaths to maintain airway patency. Ventilator weaning training was performed by adopting an appropriate progressive ventilator weaning model and a tracheal mask, and real-time assessment of breathing pattern response was performed. Cardiopulmonary tolerance exercise included rehabilitation with a pedaling device, climbing stairs, and 6-minute walking to enhance activity tolerance. Earplugs and drugs were provided to improve sleep quality. A tracheostomy speaking valve was used to enhance verbal communication. Patients were encouraged to speak out their psychological demands, and positive ideas and confidence were enhanced; thereby, anxiety was reduced, and the patient actively cooperated in the rehabilitation exercise and uneventfully weaned from the ventilator. For patients undergoing long-term weaning training, in addition to solving the physiological problems, continuous care and patience to assist them through the experience of weaning failure, improvement of the quality of care, and achieving the ultimate goal are suggested. I hereby share this nursing experience with nursing peers as a reference for providing care for similar cases in the future.