一位缺血性腦中風病人使用血栓溶解劑之急診照護經驗

An Emergency Care Experience for a Patient with Ischemic Stroke Receiving Thrombolytic Treatment

房怡慧(Yi-Hui Fang) ； 曾彥菁(Yan-Jing Tzeng) ； 盧美言(Mei-Yan Lu)

《領導護理》 17卷2期 (2016/06) Pp. 58-69

https://doi.org/10.29494/LN.201606_17(2).0006

摘要

本文描述照護一位急性缺血性腦中風病人，於黃金時間3小時內使用血栓溶解劑之急診護理經驗，護理期間為2014年07月11號09點14分至14點10分，運用Gordon十一項功能性健康型態作為評估工具，藉由身體評估、理學檢查、觀察及會談方式收集資料，確立護理問題有：「組織灌流改變：腦／與腦血管血流受阻有關」、「焦慮／與急性缺血性腦中風住院有關」、「照顧者角色緊張／與照顧經驗不足及病人病情預後無法預期有關」。首先透過主動關懷及鼓勵表達內心感受，與個案及主要照顧者建立良好的護病關係，並運用醫療團隊合作及衛教光碟，協助病人及家屬認識腦中風及血栓溶劑治療的優缺點，讓家屬在急性期之疑慮中，可以獲得照顧個案的相關知識與幫助，使其能夠在短時間內減輕焦慮，並同意施打血栓溶解劑，以把握黃金關鍵治療時間，進而順利渡過疾病的造成的衝擊，促使個案能儘早達成日常生活的自理，及降低主要照顧者的負荷。期望透過此個案護理經驗的分享，做為日後照顧此類個案之參考，使護理人員獨特角色能得以發揮。

關鍵字

缺血性腦中風 ； 血栓溶解劑 ； 照顧者角色緊張

並列摘要

This paper describes the emergency care experience for a patient with ischemic stroke receiving emergent thrombolytic treatment within 3 hours of a stroke occurrence. The nursing period was from 9:14 to 14:10 of July 11, 2014. With the Gordon's 11 Function Health Patterns assessment tool, the author collected data through physical assessment and examination, patient observation, and patient interview. The three major identified nursing problems were altered tissue perfusion associated with blockage of blood flow in the brain, anxiety associated with hospitalization secondary to the acute ischemic stroke, and caregiver role tension associated with a lack of care experience and the unpredictable prognosis of disease. The author encouraged the patient to express all inner feelings, and the author built a good relationship with the patient and primary caregiver. With the provision of a health education CD, the patient and caregiver understood strokes better and the advantages and disadvantages of thrombolytic treatment, further relieving their anxiety. With consent, the patient received thrombolytic treatment within three hours after the stroke, successfully overcame the impacts of the disease, regained daily self-care abilities as soon as possible, and reduced the burden of the primary caregiver. We hope to share this nursing experience as a reference for nurses caring for similar patients.

並列關鍵字

ischemic stroke ； thrombolytic treatment ； caregiver role strain

參考文獻

林芳琪 、 黃煒淇 、 王玉眞 ( 2013 ) . 照護一位重覆經歷腦血管意外病人之護理經驗 , 長庚科技學刊 , 19,151-162。doi : 10.6192/C GUST.2013.12.19.13

張郁敏 、 蔣立琉 ( 2014 ) . 以家庭爲中心的急診室過渡期護理 , 護理雜誌 , 64 ( 5 ) , 91 -96 • doi:10.6224/JN.61.5.91

蕭世美 、 林靜薇 ( 2010 ) . 血栓溶解劑治療急性缺血性腦中風病人之護理 , 榮總護理 , 27 (4) , 382-387 • doi:10.6142/VGHN.27.4.382

王寶鈺 、 林梅香 、 李金英 ( 2011 ) , 一位腦中風個案於急診照護之護理經驗 , 領導護理 ， 12 (1) , 56-64 •

吳雅惠 、 陳琳嬿燕 ( 2012 ) . 照顧一位經歷莫拉克颱風之急性腦中風個案的護理經驗 . 長庚護理 , 23 ( 4 ) , 530-538 。