一位初孕婦感染肺結核之照護經驗

A Nursing Experience in Care of a Patient with Pulmonary Tuberculosis

10.6142/VGHN.202009_37(3).0010

劉欣欣(Shin-Shin Liu)；洪麗琴(Lin-Zin Hung)；陳惠君(Huei-Jiun Chen)

結核病 ； 懷孕 ； 不確定感 ； tuberculosis ； pregnant ； uncertainty

榮總護理

37卷3期（2020 / 09 / 01）

306 - 312

繁體中文

本文是照護一位懷孕十二週之肺結核感染初孕婦，面臨肺結核治療可能影響胎兒成長、傳染給家人及胎兒時的身、心衝擊之照護經驗。收案照護期間為2015年9月30日至2016年4月7日，經由身體評估、觀察、會談、病歷查閱、電訪方式收集資料，以Gordon十一項健康功能型態為評估架構，發現病人有知識缺失、不確定感、潛在危險性情境性低自尊等健康問題。藉由傾聽、陪伴、同理等技巧，建立治療性關係，回診時主動陪伴病人，並與醫師討論疾病治療計畫。提供個別性衛教、諮詢及用藥後副作用追蹤，同理病人服用結核藥後之生理不適、擔心家人受傳染、或胎兒畸型之感受，給予情緒支持及矯正對疾病的誤解。首次照護初孕婦罹患肺結核感染病人，其面臨的健康問題涉及婦產科、兒科及藥師各層面，有賴各專業以跨團隊合作模式共同提供照護，可建立跨團隊照護指引，提供病人的照護及支持能更即時，讓病人勇於面對肺結核治療及順利生產，期望此照護經驗能供類似病人參考。

This article describes the experience of a nurse in caring for primaparae with pulmonary tuberculosis (TB) who received TB treatment. Nursing care was provided between September 30, 2015, and April 7, 2016. Data were collected through observation, interview, chart review, and discussion with the medical team. Physical examination, continuity of care, and Gordon's 11-item Functional Health Pattern Assessment Guidelines were used to identify health and nursing problems. Four nursing problems were discovered: a knowledge deficit, inadequate nutrition (less than the physical need), uncertainty, and low self-esteem. The author not only played the role of a nursing consultant and educator but also provided nursing care including individual health education, counseling, tracking management, mental support, and empathetic conversation to decrease physical discomfort and fear. Professional assistance should be provided to those working in obstetrics and gynecology, pediatrics, and pharmacy who are involved in managing the early stage of TB infection in pregnant women. The management program for TB should be revised in a timely manner to treat patients with TB who are in their first trimester, and a communication platform should be established through interteam cooperation and care; the communication between medical clinics should occur in real time. A cross-team discussion meeting should also be held to which the team is invited to discuss the TB treatment and creation of a neonatal congenital infection treatment plan.

1. 汪郁馨,黃淑芬,陳素惠,李麗紅(2018)。照顧一位初次罹患肺結核服藥不遵從患者之護理經驗。彰化護理，25(2)，67-68。
   連結：
2. 賈如瓊,鄭淑英,張璇其,吳貞慧,黃瓊慧,張杏芬,洪曉佩(2016)。探討術前多媒體護理指導於腰椎麻醉病人焦慮之成。榮總護理，33(4)，332-343。
   連結：
3. Duko, B.,Gebeyehu, A.,Ayani, G.(2015).Prevalence and correlates of depression and anxiety among patients with tuberculosis at WolaitaSodo University and Sodo Health Center, WolaitaSodo, South Ethiopia, cross sectional study.BMC Psychiatry,15(214),1-7.
4. Mishel, M. H.(1988).Uncertainty in illness.Image: the Journal of Nursing Scholarship,20(4),225-232.
5. Sobhy, S.,Babiker, Z. O. E.,Zamora, J.,Khan, K. S.,Kunst, H.(2017).Maternal and perinatal mortality and morbidity associated with tuberculosis during pregnancy and the postpartum period: Asystematic review and meta-analysis.BJOG: An International Journal of Obstetrics & Gynaecology,124(5),727-733.
6. 周如文(2020)。概述結核病防治研究進展。防癆雜誌，春季號，2-4。
7. 邵上智,蔡明翰,蔡培癸,劉雪娥(2015)。多媒體衛教光碟合併護理指導對於初次冠心病患者在疾病知識、態度及自我照顧行為之成效探討。護理暨健康照護研究，11(3)，175-186。
8. 保羅(2017)。肺炎、肺癌、肺結核。中興工程，136，76-79。
9. 衛生福利部疾病管制署（2019 年 11 月）‧ 傳染病統計暨監視年報．取自 https://www.cdc.gov.tw/InfectionReport/Info/DRiONFTwYxu8T162Hm6yFw?infoId=AZ33ZuIu3JrS1k5MXNY7Ow.
10. 簡聖傑,姜逸群,葉國樑,黃雅文(2014)。肺結核患者社會支持與生活品質的相關研究。健康促進暨衛生教育雜誌，38，55-66。