照顧一位重症肌無力青少年之加護護理經驗

Nursing Experiences of an Adolescent Patient with Myasthenia Gravis in the PICU

謝碧玲(Pi-Ling Hsieh) ； 蔡佳玲(Jia-Ling Tsai)

《源遠護理》 2卷1期 (2008/05) Pp. 54-66

https://doi.org/10.6530/YYN.2008.2(1).07

摘要

本文是探討一位重症肌無力症青少年之加護護理經驗。護理期間自2006年3月24日至4月5日，運用Gordon十一項功能性健康型態評估個案的身、心、靈等層面的問題，經由觀察、會談、身體評估與病歷記錄等方式收集資料，確立個案的主要健康問題如下：(1)低效性呼吸型態，與痰液黏稠、呼吸肌無力無法將痰液咳出及吸入性肺炎有關；(2)睡眠型態紊亂，與因加護病房治療時間及口水多無法吞嚥需頻繁抽痰有關；(3)活動無耐力，與全身肌肉無力及住院後長期臥床休息導致活動減少有關；(4)言詞溝通障礙，與氣管內管放置及呼吸器有關；(5)心靈困擾，與疾病威脅、恐懼死亡及擔心基測成績有關。此外，在護理過程中鼓勵家屬參與照顧計畫，與個案共同面對疾病的壓力，護理人員必須用心傾聽與同理心體會個案的真實感受，設身處地持續評估與解決健康問題，使個案能維持呼吸道通暢、改善睡眠品質、增進自我照顧能力及建立適當溝通模式，協助個案及家庭達到最佳適應，讓身心創傷減到最低，並有效提升青少年及家屬的生活品質。

關鍵字

青少年 ； 重症肌無力 ； 加護護理

並列摘要

This report discusses the nursing care experiences of an adolescent patient in the pediatric intensive care unit (PICU) with a diagnosis of myasthenia gravis. Use Gordon's eleven function health patterns to assess the patient's physical, psychological and spiritual problems. The patient's main problems were: (1) ineffective breathing patterns from thick sputum, weak respiratory muscle and aspirated pneumonia, (2) disturbed sleep pattern from PICU treatment procedures and frequent oral suctions, (3) activity intolerance from muscle weakness and long term immobility, (4) impaired verbal communication due to placement of an endotracheal tube, and (5) spiritual distress from life threatening illness and worries about academic exams. Family and patient were encouraged to participate in the nursing care plans and to face the challenges. Nurses needed to listen carefully, with empathy to the patient's true feeling, and to continually evaluate and resolve the patient's problems. Nursing care included maintenance of airway pattern, improving sleep quality, enhancing self-care ability, and establishing effective communication pattern. After the nursing care, the patient and the family could adapt the disease process, minimize the physical and psychological trauma, and improve their quality of life.

並列關鍵字

adolescent ； myasthenia gravis ； intensive nursing care