肌萎縮性側索硬化症病人之護理經驗

肌萎性側索硬化症（Amyotrophic Lateral Sclerosis；ALS）為運動神經元疾病之一，此疾病平均存活時間約發病後三到四年，且死因多與呼吸衰竭相關。本文探討一位罹患肌萎縮性側索硬化症之78歲女性，因疾病惡化導致呼吸衰竭引發生理、心理社會等問題之護理過程。護理期間為2013年10月26日至2013年11月8日，作者以生理、心理、社會及靈性四大層面進行整體性護理評估。評估後發現個案有低效性呼吸型態、無望感、照顧者角色緊張等護理問題，護理過程中作者設計個別性之復健運動以降低肌力退化，同時運用傾聽、陪伴及非語言溝通方式，鼓勵個案參與自我照護，有效降低個案無望感。作者針對照護者進行技巧訓練並提供後續照護資源，以降低照護者之負荷，11月8日個案接受居家呼吸治療服務，成功轉往養護中心。筆者透過此篇個案報告分享照護經驗，期望能提供未來照護類似個案之參考。

關鍵字

肌萎縮性側索硬化症；呼吸困難；無望感；照顧者角色緊張

並列摘要

Amyotrophic lateral sclerosis (ALS) is one of the motor neuron diseases. The average survival is from three to four years after first diagnosis and the causes of death are commonly associated with respiratory failure. The purposes of this paper were to describe the nursing process of the physical and psychological experiences of a 78-year-old-female who was diagnosed with respiratory failure secondary to the progression of ALS. The author collected data from comprehensive nursing assessments in physical, psychological, social aspects, and spirituality from 26th October, 2013 to 11st November, 2013, in which problems concerning ineffective breathing pattern and hopelessness because of poor prognosis and caregiver role strain were identified. During the nursing process, in order to relieve the patient's respiratory distress, the author designed individualized exercise program to prevent her muscle from disuse atrophy. In order to reduce hopelessness, the author encouraged the patient to participate in self-care activities through careful listening, engaging and non-verbal communication. In order to decrease caregiver's load, skills training for caregiver and resources for long-term care were provided. This case was successfully discharged to nursing home with respiratory home care services on 8th November. Hopefully this nursing experience might serves as a reference for future care of patients with similar conditions.