一位腦部動靜脈畸形破裂出血病人之護理經驗

Nursing Experience of a Patient with Brain Arteriovenous Malformation Hemorrhage

涂琬甄(Wan-Chen Tu) ； 蔡素華(Su-Hua Tsai) ； 林佩昭(Pei-Chao Lin) ； 張錦雀(Chin-Chueh Chang)

《高雄護理雜誌》 36卷2期 (2019/08) Pp. 109-119

https://doi.org/10.6692/KJN.201908_36(2).0010

摘要

本文描述一位腦部動靜脈畸形破裂出血病人之護理經驗。自2014年6月19日至7月16日，用觀察、會談及身體評估發現病人意識清醒後，對於腦部動靜脈畸形破裂出血導致身體活動功能障礙、術後外觀容貌改變有許多負向想法及行為。透過電子產品輔助鼓勵病人表達內心想法，並利用主動關懷、傾聽、陪伴、同理心的技巧，協助病人重建正向之身體心像。此外，案母面對病人非預期的健康改變，主動表示不知如何照顧病人需要協助。經指導案母照護技巧，鼓勵參與照護過程，提供可利用之社會資源後，可緩解案母照顧過程的緊張及壓力。照護顱內出血的病人，除了減少病人神經損傷造成的生理問題外，更需重視病人與主要照顧者於治療過程中的心理健康，以達更完善之照護。

關鍵字

腦部動靜脈畸形 ； 身體活動功能障礙 ； 身體心像紊亂 ； 照顧者角色緊張

並列摘要

This article describes the care experience of a woman with bleeding due to arteriovenous malformations in the brain. During the nursing period from June 19 to July 16, 2014, use of observations, interviews and physical assessment found that the patient had many negative thoughts causing physical dysfunction and postoperative appearance changes for the arteriovenous malformations in the brain after consciousness. The author encouraged the patient to express her thoughts through electronic products and cared for her actively, listened, and accompanied her with empathy skills to help the patient rebuild her positive body image. In addition, the patient's mother was faced with unforeseen changes in the patient's health and actively expressed that she did not know how to take care of the patient and needed assistance and support. The author taught the patient's mother care skills, encouraged her to participate in the care process, and provided her with available social resources, and then the patient's mother was able to alleviate her tension and pressure in the care process. In addition to reducing the physiological problems caused by nerve damage in patients with intracranial hemorrhage, it is necessary to pay attention to psychological health to achieve a more complete holistic health care modality when nurses care for patients.

並列關鍵字

brain arteriovenous malformation ； physical activity dysfunction ； body image disturbance ； caregiver role strain

參考文獻

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．榮總護理，33(1)，50-59。doi:10.6142/VGHN.33.1.50

蔡惠如、曾詩蘋、王守玉、張瑛瑛、趙玉環(2016)．探討首次腦中風病人初期之調適過程．護理雜誌，63(2)，103-112。doi: 10.6224/JN.63.2.103

韓德生、林家瑋、顱璐、蕭名彥、吳爵宏、梁蕙雯…張權維(2016)．臺灣腦中風復健治療指引．台灣復健醫誌，44(1)，1-9。doi: 10.6315/2016.44(1)01

Baird, S. E. (1985). Development of a nursing assessment tool to diagnose altered body image in immobilized patients. Orthopedic Nursing, 4(1), 47-54.

Kim, T., Kwon, O. K., Bang, J. S., Lee, H., Kim, J. E., Kang, H. S., … Oh, C. W. (2018). Epidemiology of ruptured brain arteriovenous malformation: A national cohort study in Korea. Journal of Neurosurgery, 130(6), 1965-1970. doi: 10.3171/2018.1.JNS172766