一位雙相情緒障礙個案急性躁期之護理經驗

Nursing experience of a patient with acute manic episode of bipolar disorder

10.6692/KJN.202005/SP_37.0008

林欣薇(Hsin-Wei Lin)；柯貞如(Chen-Ju Ko)

躁症 ； 行為治療 ； 妄想 ； 病識感 ； manic ； behavior therapy ； delusion ； insight

高雄護理雜誌

37卷增訂刊（2020 / 05 / 01）

86 - 99

繁體中文

本文主要呈現一位雙相情緒障礙急性躁期個案因受躁症病程影響出現誇大妄想、干擾行為住院治療之護理經驗。在2014/2/1－4/23護理期間，筆者運用身體、情緒、智能、社會及靈性五大層面進行護理評估，確立個案健康問題包括：「個人因應能力失調」、「思考過程紊亂」、「社交互動障礙」及「健康維護能力改變」。護理人員針對個案躁期症狀，除協助調適情緒之外，在急性症狀稍緩解後，與個案及家屬共同訂定行為契約，運用正增強、代幣制度及處罰原則，協助個案強化自我控制能力，建立合宜的社交互動技巧。在妄想方面則應用時事新聞提供現實感，協助分辨現實與妄想的區別。病識感方面，偕同病友分享經驗，強化個案對疾病與藥物的認知，並衛教家屬協助監督服藥及辨別疾病復發徵兆，多管齊下，協助個案，調適疾病所帶來的困擾，降低復發機率。

This paper presents a nursing experience for a patient with acute manic episode of bipolar disorder. The patient was hospitalized due to grandiose delusions and disturbing behavior toward others. In the nursing period, from 1st February 2014 to 23rd April 2014, the patient's health issues were assessed according to five aspects, including physical, emotional, mental, social and spiritual dimensions. The patient's nursing problems were identified as the following, ＂Ineffective personal adaptation＂, ＂Disturbed thought processes,＂ ＂Impaired social interaction＂ and ＂Changes in health maintenance＂. Apart from emotional adaptation, nurses established a behavioral agreement with the patient and her family members. By using behavioral modification principles including reinforcement, punishment and token systems, the patient was helped to improve emotional self-control and develop proper social skills. In addition, the nurses encouraged other bipolar patients to share their experiences in improving disease awareness of patients. Furthermore, family education regarding medication and warning signs of relapse should be taught to reduce any risk of relapse.