一位腦動靜脈畸形併顱內出血青少女的護理經驗

A Nursing Experience of a Teenage Girl with Cerebral Arteriovenous Malformation and Intracranial Hemorrhage

10.6692/KJN.202005/SP_37.0007

簡瑜君(Yu- Chun Chien)；伍碧琦(Pi-Chi Wu)

動靜脈畸形 ； 言辭溝通障礙 ； 身體心像紊亂 ； arteriovenous malformation ； verbal communication ； decreased adaptive capacity ； body image disturbance

高雄護理雜誌

37卷增訂刊（2020 / 05 / 01）

73 - 85

繁體中文

本文探討一位17歲青少女因腦動靜脈畸形併顱內出血術後，導致言辭溝通模式改變之護理經驗。筆者自2018年4月17日至2018年5月2日，藉由直接照護、身體評估、觀察、查閱病歷及會談收集資料以Gordon十一項功能健康型態進行評估。確立有顱內調適能力降低、言辭溝通障礙、身體心像紊亂等健康問題。護理過程透過主動關懷、傾聽、鼓勵表達感受，說明治療過程以建立信任關係，給予個別性護理措施，藉由反覆練習物品名詞並製作圖卡，每日陪伴口語對話及閱讀朗誦增加言語表達能力，引導患者間分享及交流，教導配件的使用，降低不自在，鼓勵家屬與同儕的陪伴及讚美，建立自信及正向自我認同。希望藉此經驗分享陎對突發外觀改變與因病造成言辭溝通困難的青少女，需重視內在情緒轉換與適應過程，透過學習溝通模式與自我照顧及早回歸原有生活。

This article explores the nursing experience of a 17-year-old girl whose verbal communication changed after a cerebral arteriovenous malformation and intracranial hemorrhage. From April 17, 2018 to May 2, 2018, the author collected data on Gordon's 11-item Functional Health Assessment through direct care, physical assessment, observation, medical records and interviews. Decreased intracranial adaptive capacity, verbal communication, and body image disturbance were detected. The treatment process was explained to the patient through active care, listening, encouraging expression, establishing a trusting relationship, and providing individual care measures. By repeatedly practicing article nouns and making a map card as well as daily companion dialogue and reading recitation all increased the patient's vocal expression ability. Guiding patients to share and communicate, teaching the use of accessories, reducing uncomfortable feelings, encouraging family members and peers to accompany and praise all assisted in building confidence and positive self-identification for this case. This nursing experience could assist teenage girls who face sudden changes in their appearance and difficulty in verbal communication due to illness. They should be encouraged to pay attention to the process of internal emotional transformation and adaptation, and return to their previous lifestyle through learning communication modes and self-care.