一位顱內動脈瘤破裂患者於加護病房照護之護理經驗

Nursing Experienes of Caring for a Patient with Intracranial Aneurysm Aneurysmal Rupture in ICU

黃琳喬(Lin-Chiao Huang)；郭芳伶(Fang-Ling Kuo)

動脈瘤 ； 脫離呼吸器 ； 身體活動功能障礙 ； 照顧者角色緊張 ； Aneurysm ； Weaning of respirator ； Physical activity dysfunction ； Caregiver role strain

若瑟醫護雜誌

15卷1期（2021 / 07 / 01）

83 - 94

繁體中文

本文描述一位顱內動脈瘤破裂患者於加護病房照護之護理經驗，因個案突發疾病影響，案夫面對個案住院、手術及日後復健所累積的壓力，產生多方面不確定感，因此引發探討動機。護理期間2017年10月28日至11月9日，運用Gordon十一項健康功能型態評估發現護理問題有呼吸道清除功能失效、身體活動功能障礙及照顧者角色緊張，運用個別性護理措施，觀察神經學、監測生命徵象及給予個案及家屬心理支持，鼓勵個案儘早執行全關節運動，使提早恢復日常生活；預防呼吸器使用期間的感染，採漸進式呼吸訓練，幫助成功脫離呼吸器；透過主動關懷家屬、予照顧個案相關技能及適時給予心理支持及鼓勵，提供可利用的資源，在跨團隊合作下共同擬定復健計畫，使恢復最大生理功能，增進日後生活品質。但因加護單位會客時間有所限制且著重於急性期照護，故無法第一時間完全了解家屬的感受及需求，此為照護上限制，因此建議能提供彈性會客時間，以利家屬探視及學習照護技巧之機會。個案轉出普通病房後，持續追蹤個案復健狀況及家屬照顧上的情形，並轉介出院準備服務小組，協助個案及家屬獲得持續性照顧，使個案能維持肢體最大功能，提升生活品質，希望藉此護理經驗分享並提供護理同仁在照護類似個案參考。

This paper described the nursing experience of a patient with ruptured intracranial aneurysm in the intensive care unit. Due to the sudden impact of disease, the patient was faced with accumulation of pressure from hospitalization, operation and rehabilitation in the future, who also developed a sense of uncertainty in many aspects, which required more investigation ad discussion. During the period of nursing care, from October 28 to November 9, 2017, Gordon's 11-Function Health Patterns was performed to evaluate the patient suffering from problems, such as respiratory tract clearing function failure, physical activity dysfunction and caregiver role strain, as individual nursing measures were used to observe neurological symptoms, monitor life signs and give psychological support to the patient and family members, to encourage the patient to complete rehabilitation of whole joint as soon as possible to have an earlier recovery of daily normal life. Prevention of infection was noted during the use of respirator and with gradual respiratory training, it functioned to help the patient in weaning of respirator. Family members were actively cared by providing available resources, related rehabilitation skills and timely psychological support with encouragement. The rehabilitation plan was carried out with cross-disciplinary collaboration to maximize the full recovery of physiological function and improve the quality of life in the future. However, due to the limited visiting time and the focus on acute care, it was not possible to fully understand the feelings and needs of family members initially, posing as a limitation on nursing care. Therefore, it was suggested to provide flexible visiting time for family members to visit and learn care skills. After the patient was transferred out of the general ward, the rehabilitation progress and family care were continuously checked. The discharge preparation service group was referred to assist the patient and family members to continue the care to maintain the patient's maximum body function and improve the quality of life. The case was described to share the nursing experience and provide as reference for nursing colleagues in caring similar cases.

1. 林季誼(2017)。女性長期照顧者之社會支持與壓力探討。諮商與輔導，375，18-21。
   連結：
2. 林美伶,周學智,徐曉雲,陳麗玲(2016)。照顧一位顱內動脈瘤破裂個案出院準備服務之護理經驗。領導護理，33(1)，50-59。
   連結：
3. 張笠湘,黃秋玲(2017)。運用Swanson關懷理論照顧經濟弱勢失能患者之護理經驗。志為護理，16(1)，93-103。
   連結：
4. Singer RJ, Ogilvy CS, Rordorf G:Treatment of cerebral aneurysms. 2017Retrieded form https://www-uptodate-com.lib.chimei.org.tw/contents/treatment-of-cerbral-aneurysms?Source=search_result&search=aneurysm%20brain&selectedTitle=3~144.
5. Volsko, TA(2017).Airway clearance therapy:finding the evidence.Respiratory Care,58(10),1669-1678.
6. 楊凱玲,盧余青,郭姿子(2017)。探討慢性阻塞性肺疾病病人淺快呼吸指數數據之差異性。呼吸治療，16(2)，36。
7. 廖漢文。腦動脈瘤的治療。當代醫學年代，40(12)，24-26。
8. 衛生福利部統計處：107年死因統計結果。 2019 。 https://dep.mohw.gov.tw/DOS/lp-4472-113.html
9. 韓德生,林家瑋,盧璐,蕭名彥,吳爵宏,梁蕙雯(2016)。台灣腦中風復健治療指引。台灣復健醫誌，44(1)，1-9。