運用羅氏適應模式照護急性間歇性紫質症病人的急診護理經驗

Nursing Care Experiences of Applying Roy's Adaptation Model in Caring for the Patient with Porphyria at the Emergency Department

10.6740/NTUHJN.201801_14(1).0006

李侃如(Kan-Ru Li)；張雅琇(Ya-Hsiu Chang)；楊蓓菁(Bey-Jing Yang)

紫質症 ； 腹痛 ； porphyria ； abdominal pain

臺大護理雜誌

14卷1期（2018 / 01 / 01）

44 - 54

繁體中文

紫質症為罕見疾病，發病時常以劇烈腹痛症狀表現，臨床上易與其他相似症狀疾病混淆。本文探討一位急性間歇性紫質症個案因反覆腹痛至急診就醫的護理經驗，照護期間為2016年1月3日至1月6日，藉由直接照護、觀察、會談及身體評估進行資料收集，以羅氏適應模式為評估指引，依生理功能、自我概念、角色功能與相互依賴進行整體性護理評估，確立個案的健康問題包括疼痛、營養低於身體所需及自我評價低下。護理措施除了依醫囑予以藥物緩解症狀外，藉由傾聽、同理、陪伴等技巧，與個案建立信任護病關係，共同討論每日飲食計畫以避免營養失衡，並建立個案紀錄腹痛的頻率及緩解狀況的習慣。照護期間與個案及案母召開小型家庭會議，讓個案及其家庭成員共同參與疾病照護進而提升生活品質。建議對此類疾病個案發展後續長期照護系統以達到持續性照護的目標。

The common symptom of porphyria is the severe abdominal pain, which is often misdiagnosed as other diseases. This article described the nursing care experience of the patient with porphyria, seeking emergency help for repeated abdominal pain. Data was collected through direct care provision, observation, interviews with the patient and her family members, and physical assessment from January 3 to January 6, 2016. Based on Roy's adaptation model, the domains of the holistic nursing assessment included physical function, self-concept, role function, and interdependence. The patient's health problems were then identified, which included pain, nutrition imbalanced less than body requirements, and self-devaluation. In addition to providing medication for symptoms relief, nurses applied the skills of listening and empathy with accompany to establish the therapeutic nurse-patient relationship. Moreover, we discussed a diet plan with the patient to avoid the nutritional imbalance and guided the patient to develop the ability of recording the changes in abdominal pain intensity and frequency. The nurse initiated a meeting between the patient and her family members, to encourage their participation in the care plan and, thereby, improve the patient's quality of life.