一位神經性厭食症患者之護理經驗

The Nursing Experience of an Anorexia Nervosa Patient

10.3966/102673012017062802017

徐育生(Yu-Sheng Hsu)；蔡麗紅(Li-Hung Tsai)

神經性厭食症 ； 營養不均衡 ； 少於身體需要 ； 活動無耐力 ； 身體心像紊亂 ； anorexia nervosa ； imbalanced nutrition ； less than body requirements ； activity intolerance ； disturbed body image

長庚護理

28卷2期（2017 / 06 / 01）

380 - 392

繁體中文

本文旨在描述一位神經性厭食症個案因長期節食，所造成的生理及心理衝擊之護理經驗。護理期間自2014年2月3日至2014年3月4日。筆者運用Gordon十一項健康功能型態評估，確立個案有：「營養不均衡：少於身體需要」、「活動無耐力」及「身體心像紊亂」之健康問題。於護理過程中，運用傾聽、陪伴及主動關懷的方式，與個案建立良好的護病關係，藉由增加個案疾病的認知、教導採少量多餐及漸進增加熱量的攝取，進而恢復正常的飲食型態；運用漸進式下床活動計畫及教導增加肌肉力量的運動方法，以改善活動無耐力；在身體心像方面，鼓勵個案表達自我的看法，並提供正確的訊息，另外協助個案了解自己的優點、欣賞自己身體的獨特性、教導利用打扮修飾身體外觀，以重新建立正向的身體心像，進而增加與他人的人際互動。建議未來遇到類似的個案可以舉辦醫護聯合討論會，邀請醫師、營養師、心理師一起分享及探討，並邀請個案的家屬也參與討論，如此個案能得到更周全的照護。盼藉此經驗能提供護理人員作為日後照顧類似病人之參考。

This case report describes the nursing experience of an anorexia nervosa patient, who needed to deal with physical symptom and psychological impact. The nursing period was from February 3 to March 4, 2014. Based on the data analyzed by the assessment tool of Gordon's 11 functional health patterns, the patient's nursing problem included imbalanced nutrition: less than body requirements, activity intolerance, and disturbed body image. During the period of caring, the author provided companionship, listening, and caring in order to establish a trust relationship with the patient. The patient was instructed to restore normal diet pattern by strengthened her recognition of the disease, to eat more frequent and smaller meals, and to increase caloric intake gradually. Moreover, the patient was taught to initiate progressive ambulation plans and increase muscle strength exercise to improve activity intolerance. In addition, the patient was encouraged to express her opinion of body image, provided with accurate information. She was able to re-establish a positive body image by understanding her own strengths, appreciating the uniqueness of her body. She was taught to dress up to modify appearance and increase social interaction. It is suggested that an effective treatment plan can involve doctors, nurses, nutritionists, psychologists, and family members. The finding can serve as a reference for caring similar anorexia nervosa patients.

1. 張家禎、鄒孟婷、陳薇光、張倍禎(2012)。厭食症淺介。家庭醫學與基層醫療，27(9)，314-318。
   連結：
2. Espeset, E. M. S.,Nordbø, R. H. S.,Gulliksen, K. S.(2011).The concept of body image disturbance in anorexia nervosa: an empirical inquiry utilizing patients' subjective experiences.Eating Disorders,19(2),175-193.
3. Fisher, B. A.,Schenkman, M.(2012).Functional recovery of a patient with anorexia nervosa: physical therapist management in the acute care hospital setting.Physical Therapy,92(4),595-604.
4. Gavin, A. R.,Simon, G. E.,Ludman, E. J.(2010).The association between obesity, depression, and educational attainment in women: the mediating role of body image dissatisfaction.Journal of Psychosomatic Research,69(6),573-581.
5. Harrington, B. C.,Jimerson, M.,Haxton, C.,Jimerson, D. C.(2015).Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa.American Family Physician,91(1),46-52.
6. Lewis, S.,Thomas, S. L.,Blood, R. W.,Castle, D. J.,Hyde, J.,Komesaroff, P. A.(2011).How the different types of obesity stigma that they encounter in their daily lives? a qualitative study.Social Science & Medicine,73(9),1349-1356.
7. Nicholls, D.,Hudson, L.,Mahomed, F.(2011).Managing anorexia nervosa.Archives of Disease in Childhood,96(10),977-982.
8. Obadina, S.(2014).An overview of anorexia nervosa, bulimia and binge eating disorder.British Journal of School Nursing,9(9),441-446.
9. Wood-Barcalow, N. L.,Tylka, T. L.,Augustus-Horvath, C. L.(2010)."But I like my body": positive body image characteristics and a holistic model for young-adult women.Body Image,7(2),106-116.
10. Zugai, J.,Stein-Parbury, J.,Roche, M.(2013).Effective nursing care of adolescents with anorexia nervosa: a consumer perspective.Journal of Clinical Nursing,22(13/14),2020-2029.
11. 呂孟純、楊美都、何琅鈴、詹吟菁(2013)。營養介入對居家失能營養不良老人病患營養狀況效益。台灣營養學會雜誌，38(2)，60-70。
12. 林荷芳(2010)。厭食症的診斷與治療。諮商與輔導，300，20-25。
13. 張瓈方、張乃文、王桂芸(2010)。身體心像紊亂之概念分析。長庚護理，21(1)，25-32。
14. 蔡璧光、劉芹芳、許心恬(2012)。應用腳踏復健器之運動方案改善心臟衰竭個案之活動無耐力。護理雜誌，59(5)，103-110。

1. 黃鴻鈞,洪偉欽,姚韋如(2022)。運動與厭食症：適應身體活動及運動處方觀點。中華體育季刊，36(2)，201-210。