運用出院準備服務於一位肌萎縮側索硬化症個案之護理經驗

Nursing Experience of Applying Discharge Preparation to Serve an Amyotrophic Lateral Sclerosis Case

10.29494/LN.202106_22(2).0005

洪暄惠(Hsuan-Hui Hung)；陳怡如(Yi-Ru Chen)；楊凱婷(Kai-Ting Yang)

肌萎縮側索硬化症 ； 出院準備服務 ； 照護者角色緊張 ； amyotrophic lateral sclerosis ； discharge planning

領導護理

22卷2期（2021 / 06 / 01）

63 - 79

繁體中文

本文描述一位肌萎縮側索硬化症個案於亞急性呼吸照護病房之護理經驗，照護期間為2017年1月18日至2017年2月10日，藉由手勢、唇型、筆談、身體評估、查閱病歷資料等方式收集資料，採用Gordon十一項功能性健康評估為工具，確立健康問題：一、低效性呼吸型態；二、身體活動功能障礙；三、焦慮；四、照護者角色緊張。因個案確診退化性疾病，需長期依賴呼吸器使用，心理衝擊甚大，故藉由訓練呼吸肌力量、安排復建計畫，協助解決個案擔憂問題，並適時給予鼓勵建立自信心，以增進疾病控制感，而家屬為完成個案返家心願，面臨需學習照護技能之壓力，故藉由出院準備服務計畫，協助學習居家型呼吸器使用及返家相關照護，使其獲得良好生活品質；並期盼藉此臨床經驗分享，提供護理人員日後照護此類個案之參考。

This report describes the nursing experience of an amyotrophic lateral sclerosis patient in the sub-acute respiratory care unit. The nursing care took place from January 1 to February 10, 2017. Data collection method included gesturing, lip reading and hand-writing for the communication, as well as physical assessment and reviewing medical history. Through the Gordon's Eleven Functional Health Pattern assessment, the patient's health problems were identified as: (1) ineffective breathing pattern, (2) impaired physical mobility, (3) anxiety, and (4) caregiver role strain. Being diagnosed of a degenerative disease, the patient was confirmed to be life-long dependent on the mechanical ventilator and hence resulting in extreme psychological impacts. Nursing interventions of respiratory muscle training, rehabilitation plan, and psycho-social consultation were introduced as the care plans. As well as the emotional support improved the patient's self-confidence to control the disease. As to the discharge plan, it involved education of home-used ventilator and daily care skills for the family, which can ensure the patient's life quality. This report aims to provide as a reference to nurses when caring the amyotrophic lateral sclerosis patient in the future.

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