照護一位紅斑性狼瘡併發脊髓炎青少女護理經驗

Nursing Experience of Caring for a Female Adolescent with Lupus Erythematosus Complicated with Myelitis

10.6142/VGHN.202203_39(1).0010

蔡郁婷(Yu-Ting Tsai)；余培筠(Pei-Yun Yu)；游雅蘭(Ya-Lan Yu)

紅斑性狼瘡 ； 羅氏適應理論 ； 脊髓炎 ； lupus erythematosus ； Roy's adaptation model ； myelitis

榮總護理

39卷1期（2022 / 03 / 01）

89 - 95

繁體中文

本文敘述一位18歲少女，因紅斑性狼瘡併發急性脊髓炎，導致肚臍以下肢體癱瘓麻痺，急性期接受血漿置換術及恢復期復健照護之加護經驗。護理期間自2019年3月14日至3月30日，筆者運用羅氏適應模式進行整體性評估，經由觀察、會談與身體評估，確立病人有身體活動功能障礙、無效性因應能力及高危險性感染之健康問題。透過跨領域團隊合作，協助病人在生理層面、自我概念、角色功能、相互依賴各方面不斷調適並適應，控制病情、恢復正常生理機能；透過藝術治療、良好家庭支持及同儕鼓勵等減輕其內心壓力，並讓家屬參與學習照護，積極協助病人進行復健運動，增加肌耐力，運用體感遊戲等提升肢體之活動功能，建議未來照護類似病人時，在疾病復原過程中，能提升照顧者照護能力及病人自我照顧效能，讓病人在經歷重大身體改變後，能以正向且積極態度面對疾病、接納自我，早日重返校園，期藉此照護經驗分享，提升照護品質。

This study describes the ICU care experience for an 18-year-old girl with acute spondylitis complicated by lupus erythematosus, resulting in paralysis of the limbs below the belly button, as well as experience for acute plasma exchange surgery and the rehabilitation experience in the recovery period. The care period was from March 14 to March 30, 2019. Roy's adaptation model was used to perform an overall assessment, and observations, interviews, and physical assessment were used to identify the health problems and nursing problems of the patient with physical dysfunction, ineffective coping ability, and high-risk infection. A cross-disciplinary team was formed to help the patient make continual adjustments and adaptations in the physiological aspect, self-concept, role function, and mutual dependence to control the disease condition and regain normal physiological mechanisms. Art therapy, family support, and peer encouragement were used to reduce inner pressure, and somatosensory games were used to improve the activity function of the limbs, enable the patient to face significant physical changes and to positively and aggressively face the disease, improve self-confidence, accept the self, and return to campus life early. Hopefully, sharing the experience of caring for this patient may help other nursing colleagues taking care of similar patients in the future.

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