- 期刊
照顧一位急性腦中風病人施打血栓溶解劑之急診照顧經驗
Emergency Nursing Experience of a Patient with Acute Stroke and Undergoing Thrombolytic Treatment
摘要
本文描述一位78歲女性因急性缺血性腦中風於急診就醫之護理經驗，個案及家屬對於突然的肢體無力，又面臨須立即決策是否接受血栓溶解劑的治療，感到焦慮、無助、不知所措，引起撰寫本文之動機。護理期間於2019年8月31日08:06到11:57，以生理、心理、社會、靈性四大層面評估，藉由直接照顧、身體評估、觀察及會談等方式收集資料，確立個案有腦組織灌流改變、焦慮及照顧者角色緊張健康問題。照護過程依醫囑給予輸液補充及血栓溶解劑治療，控制血壓在適當範圍，以改善腦組織灌流不足的問題，恢復肢體活動功能，且無血栓溶解劑治療造成的合併症出現；給予主動關懷、情緒支持、提供相關訊息，使個案及家屬因突發身體功能喪失、擔心失能的焦慮感得以減輕；醫療團隊鼓勵家屬說出擔心的事情，配合腦部電腦斷層影像的解釋，讓家屬了解治療的作用及副作用，及時做出決策，並主動帶領家屬一起參與照護，讓其對於後續照護更有信心，減輕照顧者角色緊張的問題。血栓溶解劑的黃金治療期為中風發作三小時內及到院60分鐘內施打，其攸關疾病預後，建議急診醫護人員應能提供淺顯易懂的腦中風血栓溶解劑治療衛教訊息，減少病家的決策衝突，期望此照護經驗可做為日後急診護理師照顧類似個案之參考。
並列摘要
This paper presents the nursing experience of caring for a 78-year-old woman with acute ischemic stroke combined with sudden weakness in limbs, who was experiencing depression, helplessness, and a feeling of being overwhelmed while confronting an immediate decision regarding whether to undergo thrombolytic therapy. The nursing care spanned 08:06 to 11:57 on August 31, 2019. We collected data through comprehensively assessment covered physical, psychological, social, and spiritual dimensions using hands-on care, physical assessments, observations, and interviews. After analyzed the data, the following health problems were confirmed which included changes in tissue perfusion, anxiety, and caregiver role tension. During the nursing process, in addition to fluid administration and thrombolytic therapy, the blood pressure was carefully maintained to optimize cerebral perfusion and facilitate physical function recovery, and the potential complications associated with thrombolytic therapy have been prevented. Active caring, emotional support, and relevant information were provided to alleviate the patient's and family's anxiety regarding the sudden physical dysfunction and disability experienced. The medical team actively encouraged family members to express their concerns and collaborated in interpreting and explaining brain CT images, ensuring that the family members fully understood the treatment's direct effects and potential side effects. This approach enabled the family to make informed decisions and actively participate in the patient's care, fostering confidence and reducing caregiver tension. The golden period, best treatment time, of administering thrombolytic treatment of stroke is within 3 hours of onset and within 60 minutes of arrival at the hospital. This period is crucial for disease prognosis. Nurses in the emergency department should be able to provide easy-to-understand information regarding thrombolytic treatment for stroke. This proactive education approach aims to minimize decision-making conflicts between patients and families. We hope this nursing experience can serve as an example for nurses caring for similar patients in the future.