一位巨結腸症合併注意力不足過動症孩童接受居家靜脈營養治療之護理經驗

A Nursing Experience in a Child with Hirschsprung's Disease Complicated by Attention Deficit Hyperactivity Disorder Receiving Home Parenteral Nutrition Therapy

楊于青(Yu-Ching Yang)；劉瑋玲(Wei-Ling Liu)

巨結腸症 ； 注意力不足過動症 ； 居家靜脈營養治療 ； Hirschsprung's disease ； attention deficit hyperactivity disorder ； home parenteral nutrition therapy

若瑟醫護雜誌

14卷1期（2020 / 07 / 01）

71 - 85

繁體中文

本文是描述一位因巨結腸症腸道吸收障礙合併注意力不足過動症病童，協助接受居家靜脈營養治療之護理經驗。筆者為靜脈營養專責護理師，照護期間自2017年2月24日至2017年3月6日，藉由病歷查閱、會談、觀察等技巧以Gordon十一項功能健康型態功能評估，依其個別性，擬訂適切護理計畫，確立護理問題有營養不均衡少於身體所需，與巨結腸症有關、恐懼與侵入性治療有關 、親職功能障礙與案童患有注意力不足過動症有關及照顧者角色緊張與學習居家靜脈營養照顧技巧有關。照護過程中教導主要照顧者專業知識並連結長期照護及社會資源，建議現正是孩童習慣和性格的塑造期，不可因病情過度溺愛，才能使其提高自我照顧能力，擁有正向的態度，養成良好生活習慣。出院後藉由電訪、門診追蹤及居家訪視案童於使用居家靜脈營養及注意力不足過動症治療情形，使其獲得持續性照顧。期望能藉此照顧經驗，讓醫護人員了解兒童居家靜脈營養照護指引，確保於居家環境中使用靜脈營養治療能夠安全，也讓病童及照顧者得到適當的醫療與照護，讓家庭維持既有功能，減少因住院所耗費之龐大醫療費用，進而提升生活品質。

This article describes a nursing experience in a child with intestinal malabsorption and attention deficit hyperactivity disorder. The author is a special nurse for parenteral nutrition. During the period of care from February 24, 2017 to March 6, 2017, Gordon's eleven functional health status assessments were evaluated by medical records, interviews, observations, etc. to develop appropriate care plans. The nursing problems include nutritional imbalances ( less than the body needs, related to Hirschsprung's disease), fear ( related to invasive treatment), parental dysfunction( related to the child's attention deficit hyperactivity disorder) and nervousness of caregiver ( related to learning the care skills about home parenteral nutrition) . During the care process, the main caregiver's professional knowledge is taught and the long-term care and social resources are linked. It is suggested that it is the child's habit and personality shaping period, and he should not be spoiled, so that he can improve his self-care ability and has a positive attitude toward daily living. After discharge, the child is cared with outpatient visits and home visits to monitor the progress of parenteral nutrition and attention deficit hyperactivity disorder. It is expected, from my experience, that the medical staff can better understand the guidelines for children's home parenteral nutrition care, the safety about the use of parenteral nutrition therapy in the home environment can be ensured, appropriate care for sick children and caregivers to maintain the family's existing functions can be provided, the huge medical expenses incurred by hospitalization can be reduced, and thus the quality of life can be improved.

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