照顧一位顱內動脈瘤破裂個案出院準備服務之護理經驗

Nursing Care and Discharge Planning Services Provided for a Patient with a Ruptured Intracranial Aneurysm

林美伶(Mei-Ling Lin) ； 周學智(Hsueh-Chih Chou) ； 徐曉雲(Hsia-Yun Hsu) ； 陳麗玲(Li-Lin Chen)

《榮總護理》 33卷1期 (2016/03) Pp. 50-59

https://doi.org/10.6142/VGHN.33.1.50

摘要

本篇係探討一位顱內動脈瘤破裂導致蜘蛛膜下腔出血個案，經過手術治療仍遺留了神經損傷症狀需要依賴他人照顧，透過出院準備服務團隊協助順利出院之護理經驗。照護期間自2013年5月21日至2013年6月5日，筆者運用Gordon十一項健康功能型態進行評估，確立潛在危險性腦組織灌流失效、身體活動功能障礙、自我照顧能力缺失、家庭因應能力增進的準備度等健康問題。透過意識、生命徵象監測及分散護理等降低顱內壓升高之護理措施，使住院期間未發生顱內壓升高合併症；安排積極復健計畫使右側肢體乏力逐漸改善並於扶持下站立5分鐘；提供日常活動的教導與協助，女兒能獨自執行照護技巧；面對家屬即將出院的慌亂無助，運用跨團隊醫療小組提供出院準備服務讓家屬獲得充分資訊並及早介入，建議除了持續定期開會討論，護理師應隨時與各團隊密切聯繫，依據病情變化及需求調整出院計畫，並於出院後依需要增加電訪頻次，了解照護問題並提供諮詢，以建立家屬自信心，使個案出院後能持續得到妥善照護。

關鍵字

顱內動脈瘤 ； 出院準備服務

並列摘要

This paper focuses on the experience of the authors in providing nursing care and discharge planning services through the teamwork to a patient with an intracranial aneurysm rupture caused by subarachnoid hemorrhage; the patient relied on caregiving by others owing to postsurgery nerve damage symptoms. The nursing period was from May 21 to June 5, 2013. During this period, Gordon’s 11 functional health patterns assessment was used to identify health concerns, including the potential cerebral tissue perfusion failure risk, physical activity dysfunction, selfcare defi cit, and family resource preparation inability. To prevent the complications of intracranial hypertension, intracranial pressure was reduced through awareness, vital signs were monitored, and nursing care was administered during hospitalization. Furthermore, an active rehabilitation program was initiated to gradually improve right limb weakness and aid the patient in standing up with support for 5 min. The patient’s daughter was provided guidance and assistance regarding the care skills that are required for daily activities. Thus, for families that are apprehensive about their family members’ imminent discharge, using early intervention and interdisciplinary teamwork to provide sufficient information is recommended, along with regular meetings with doctors and constant contact with the team of nurses. Moreover, the discharge plan can be adjusted according to patient condition, and the frequency of postdischarge telephone interviews can be increased as required. Thus, understanding care concerns and providing advice is pertinent to increasing the self-confidence of families of patients to ensure appropriate patient care after discharge.

並列關鍵字

intracranial aneurysm ； discharge planning

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