一位抗結核藥物治療誘發史蒂芬強生症候群之護理經驗

Adverse drug reaction with Steven Johnson syndrome that occurred in a patient who has been taking drugs to treat tuberculosis

10.29494/LN.201806_19(2).0007

林雅涵(Ya-Han Lin)；莊寒玉(Han-Yu Chuang)；林宜青(Yi-Ching Lin)

結核病 ； 史蒂芬強生症候群 ； 藥物不良反應 ； 護理經驗 ； Tuberculosis ； Steven Johnson Syndrome ； adverse drug reactions ； nursing experience

領導護理

19卷2期（2018 / 06 / 01）

78 - 90

繁體中文

當使用任何藥物時，在個體身上產生的各種副作用，我們稱之「藥物不良反應」，猶如本文所敘述之個案爲一位抗結核藥物治療誘發史蒂芬強生症候群，就是藥物不良反應最典型的病人。本案護理期間爲2015年8月9日至9月7日，運用身體評估、觀察及溝通，透過Gordon十一項功能性健康型態評估，發現病人主要健康問題有急性疼痛（與皮膚、黏膜破損有關）、皮膚完整性受損（藥物反應引起史帝芬強生症候群皮膚病變有關）、焦慮（與疾病治療及結核病傳染有關）。針對病人健康護理問題提供個別且獨立的護理措施，教導家屬皮膚照護技巧及合宜的營養支持，改善疼痛、增加皮膚修復能力，適時給予支持，降低病人焦慮及生理上的不適，減輕病人對於服藥後所帶來的焦慮及不安，使病人調整藥物過程中，不再徬徨無助，終能調整至合適藥物。藉由醫療團隊共同努力，增強病人後續治療的信心，成功協助病人返家並銜接都治計畫（Directly Observed Treatment Short-Course，DOTS）。期盼藉此臨床經驗分享，提供護理人員日後照護此類病人之參考。

Adverse drug reactions are defined as any unwanted reactions caused by a defined drug that occurs in an individual who has taken that particular drug for any reason. The following report records a typical case of a patient undergoing adverse drug reactions with Steven Johnson syndrome whilst taking drugs to treat tuberculosis. Between August the 9^(th) to September the 7^(th), 2015, physical examinations, clinical observations, verbal interrogations and Gordon's Eleven Functional Health Evaluation score were used to evaluate the patient's condition. The three main nursing problems identified were: (1) acute pain and suffering due to skin and mucosal damage; (2) loss of skin integrity directly related to the development of Steven Johnson Syndrome; (3) anxiety related to a lack of knowledge about the cause and the treatment of tuberculosis. The individualized and self-sufficient strategies were performed to help the patient overcome helplessness and learn to accept and comply with medication adjustments were as followed: (1) teaching family members techniques for skin care and adequate nutritional support; (2) providing pain control and specific indications to improve repair of the skin; (3) relieving the patient's physico-psychological distress and reducing anxiety and insecurity associated with medication intake. The patient returned home and was under the Directly Observed Treatment, Short Course (DOTS) thereafter. Through this case presentation, nursing teams responsible for caring for patients experiencing severe adverse drug reactions may have an example and guide when encountering similar cases.

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