照顧一位缺氧性腦病變合併吞嚥障礙個案之護理經驗

A Nursing Care Experience of a Hypoxic Encephalopathy Patient with Dysphagia

10.6540/NTJN.202209_24(2).0012

胡珮婕(Pei-Chieh Hu)；陳佳雯(Chia-Wen Chen)；徐珮瑀(Pei-Yu Hsu)

缺氧性腦病變 ； 吞嚥障礙 ； 身體心像紊亂 ； hypoxic encephalopathy ； dysphagia ； body image disturbance

新臺北護理期刊

24卷2期（2022 / 09 / 01）

128 - 136

繁體中文

本文描述一位個案因感冒併發心肌炎，引起心因性休克造成缺氧性腦病變，而導致肢體功能改變及吞嚥障礙，因無法接受其改變而出現負面情緒及行為之護理經驗。照護期間為2019年3月7日至4月2日，筆者以Gordon十一項健康功能評估為架構，藉身體評估、觀察、會談等方式收集資料，確立個案有：吞嚥障礙、身體活動功能障礙、身體心像紊亂之健康問題。運用跨團隊之合作模式，與個案、家屬、醫師及復健師共同擬定復健計畫，使個案主動參與復健活動，協助個案執行吞嚥訓練，衛教口腔清潔、進食姿勢等注意事項，會診營養師依個案所需提供飲食衛教，最終成功移除鼻胃管。邀請個案參與復健病友會，介紹年齡相仿且樂觀病友互相認識，使個案能提升信心以加強個案正向積極價值觀，藉由積極復健促使四肢肌力提升，增進自我照顧能力。因復健為漫長療程，易產生負面心理問題，需以耐心及同理心與個案建立信任護病關係，讓個案接受疾病導致肢體功能及外觀的改變，積極參與復建計畫，以提升自我照顧能力及提高生活品質，期望透過分享此報告，提供同仁日後照護此類個案之參考。

This case report documented the nursing experience of caring a patient who caught a cold with complication of myocarditis, causing cardiogenic shock and hypoxic encephalopathy which led to dysphagia and functional disabilities. Since the patient could not accept the change, he showed negative emotions and behaviors. The nursing care period was from March 7 to April 2, 2019. The author adopted Gordon's 11 functional health patterns to collect and analyze the information about the patient with physical assessment, observation, and interview. The results revealed that the patient's health problems were dysphagia, impaired physical mobility, and body image disturbance. We used the cross-team and cross-professional cooperation model to work out a rehabilitation plan, and drew up the plan with the patient, his family, physicians and rehabilitation therapists, so that the patient could participate in rehabilitation activities actively. We not only assisted the patient in swallowing training but did the health education of oral hygiene and correct eating posture, and consulted dietitian to provide the patient with suitable diet. Finally, the patient removed the nasogastric tube successfully. During the care process, we invited the patient to join in the rehabilitation patient association and introduced other optimistic patients who had the similar age with the patient. It enabled the patient to increase his confidence, strengthen the positive values, enhance the muscle strength of the limbs by active rehabilitation, and improve the ability of self-care. Because of long term rehabilitation, it was easy to make the patient suffer from psychological problems. We established a trustful Nurse-client relationship to the patient by patience, empathy, and emotional support. We also let the patient accept the body image and participate in rehabilitation activities, thereby enhancing self-care ability and improving the quality of life. It is hoped that through the sharing of this report, the experience can be a reference for similar nursing cares in the future.

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