一位青春期厭食症個案之照護經驗

Nursing Experience from Caring an Adolescent Patient with Anorexia

10.29494/LN.202112_22(4).0005

傅柏畯(Po-Chun Fu)；林靖芸(Jing-Yun Lin)

厭食症 ； 營養狀況改變：少於身體所需 ； 身體心像紊亂 ； 家庭因應失能 ； anorexia ； malnutrition ； body image disturbance ； disabled family coping

領導護理

22卷4期（2021 / 12 / 01）

56 - 70

繁體中文

厭食症是飲食障礙症之一，為結合生理與心理層面複雜的疾病，死亡率高達5%－20%。本文描述一位14歲青春期少女罹患厭食症之護理經驗，個案因很在意身體外觀與別人看法，擔心自己變胖，透過節食讓體重驟降，產生情緒暴躁、思緒無法集中，影響身體功能運作，因而引發筆者撰寫動機。護理期間自2018年12月18日至2019年1月8日，以身體、情緒、智能、社會及靈性五大層面進行整體性護理評估，運用觀察、主動關懷與陪伴、訪談及實際照顧等方式進行資料收集，發現個案有營養狀況改變：少於身體所需／與不正常飲食型態有關、身體心像紊亂／對身體外觀有負面感受有關及家庭因應失能／與家庭成員無效的溝通模式有關等健康護理問題。照護期間協同醫療團隊訂定飲食計劃，使個案了解正確的飲食觀念，逐步增加體重，監測血中電解質，改善營養狀況與體重；透過支持性治療，澄清疑問，建立病識感，維持正向身體心像，協助改善家庭功能於護理過程中，改善家庭成員對立關係，使家庭功能維持正常運作，逐漸建立對自己的肯定及正向看法與修復家庭功能。期望藉此案例之經驗分享，協助護理人員作為往後照護厭食症個案之參考。

Anorexia is an eating disorder with complex disease that involves both physiological and psychological exposure. It has a mortality rate as high as 5%-20%. This study describes the experience of providing nursing care to a 14-year-old adolescent female patient with anorexia. The patient was very concerned about her physical appearance as well as the opinions of others, and was also anxious about getting fat. She experienced sudden weight loss through fasting, and subsequently, she became irritable and was unable to concentrate, and further affected some of her body functions. These events motivated the author to write about this caring experience. The period of care started from December 18, 2018 to January 8, 2019. A holistic nursing assessment framework based on the five dimensions of health aspects (physical, emotional, mental, social, and spiritual) was employed. Data was collected through observations, by initiate care and companionship, interviews, and practical care. The patient was diagnosed to have several health problems such as malnutrition that could be related to her irregular dieting; body image disturbance arising from her negative feelings related to her physical appearance; and dis-functional family system, which was linked to the ineffective modes of communication with her family members. During the period of care, a nutrition program was developed with the assistance of the medical team, which allowed the patient to understand healthy diet, gradually gain weight, and improve her nutritional status, while also enabling the medical team to monitor her blood electrolyte levels. By providing supportive therapy, clarifying the patient's queries, and assisting the patient to develop intellectual insight and maintain a positive body image, the team assisted the patient to improve her family's functioning throughout the caring period. By doing so, the conflicts between the patient and her family members were resolved, the family's situation returned to normal, and the patient gradually began to regain her self-esteem, optimism, and intention to restore her family's function. This experience is expected to serve as a future reference for healthcare professionals when provide care to anorexic patients.

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