運用早期復健運動協助一位自發性顱內出血年輕病人之加護照護經驗

Early Rehabilitation and Mobilization for a Young Patient with Spontaneous Intracranial Hemorrhage in Intensive Care Unit

10.6740/NTUHJN.202007_16(2).0009

張秀霙(Shiou-Ying Chang)；謝秀容(Hsiu-Jung Hsieh)

顱內出血 ； 早期復健 ； 無力感 ； 年輕病人 ； intracerebral hemorrhage ； early rehabilitation ； powerlessness ； young adult

臺大護理雜誌

16卷2期（2020 / 07 / 01）

88 - 99

繁體中文

本文係描述一位年輕男性因自發性顱內出血，導致右側肢體無力之加護照護經驗，個案年輕面臨突如其來的中風，導致情緒低落、害怕日後生活無法自理、對人生感到絕望而不願意配合復健，故引發探討動機。護理期間自2017年2月25日至3月9日，藉由直接照護、觀察、會談、傾聽、身體評估等方式收集資料，依個案生理、心理、社會與靈性等層面進行整體性護理評估，確立個案有腦組織灌流改變、肢體活動功能障礙、無力感等健康問題。照護過程中除了監測個案生命徵象及神經學變化外，提供早期、個別化的復健運動強化肌力，及使用平板電腦與通訊軟體協助個案以正向積極的態度面對疾病、未來的復健及維持社交功能，經由以上措施，個案從一開始不願意復健，到後來生命徵象穩定下積極配合復健計畫，並於轉出加護單位前可於協助下坐於床緣15分鐘。根據此個案照顧經驗，建議護理師在急性期照護時需全面評估病人的身心狀態，了解其需求，於治療過程中增加病人的信心，進而降低無力感，促進病人功能早期回復；加護單位可推廣早期復健概念，針對醫療人員進行復健運動的在職教育，期望藉此護理經驗，提供護理人員日後照護類似病人之參考。

This article described the nursing care experience of a young male adult suffering from the right hemiplegia after spontaneous intracerebral hemorrhage. After the stroke, he was afraid of a life requiring self fully dependent on others and felt hopeless, therefore, he did not have the motivation for rehabilitation. During the nursing period from February 25 to March 9, 2017, we conducted the physical, psychological, social, and spiritual aspects of assessment through direct care, observation, interviews, active listening, and a physical assessment. The patient's main health problems were brain tissue perfusion changes, impaired physical mobility, and powerlessness. In addition to monitoring the patient's vital signs and neurological deficits, early and personalized rehabilitation was provided. To help the patient express his feelings, we assisted him to use a computer tablet and communication software. After nursing care, he showed a positive attitude toward his future social functions. The in-service education of an early rehabilitation in the ICU needs to be provided to enhance the patient's early recovery. This nursing care experience can be applied for the patients with stroke in ICU.