一位神經性厭食症患者之護理經驗

本文旨在描述一位神經性厭食症個案因長期節食，所造成的生理及心理衝擊之護理經驗。護理期間自2014年2月3日至2014年3月4日。筆者運用Gordon十一項健康功能型態評估，確立個案有：「營養不均衡：少於身體需要」、「活動無耐力」及「身體心像紊亂」之健康問題。於護理過程中，運用傾聽、陪伴及主動關懷的方式，與個案建立良好的護病關係，藉由增加個案疾病的認知、教導採少量多餐及漸進增加熱量的攝取，進而恢復正常的飲食型態；運用漸進式下床活動計畫及教導增加肌肉力量的運動方法，以改善活動無耐力；在身體心像方面，鼓勵個案表達自我的看法，並提供正確的訊息，另外協助個案了解自己的優點、欣賞自己身體的獨特性、教導利用打扮修飾身體外觀，以重新建立正向的身體心像，進而增加與他人的人際互動。建議未來遇到類似的個案可以舉辦醫護聯合討論會，邀請醫師、營養師、心理師一起分享及探討，並邀請個案的家屬也參與討論，如此個案能得到更周全的照護。盼藉此經驗能提供護理人員作為日後照顧類似病人之參考。

關鍵字

神經性厭食症；營養不均衡；少於身體需要；活動無耐力；身體心像紊亂

並列摘要

This case report describes the nursing experience of an anorexia nervosa patient, who needed to deal with physical symptom and psychological impact. The nursing period was from February 3 to March 4, 2014. Based on the data analyzed by the assessment tool of Gordon's 11 functional health patterns, the patient's nursing problem included imbalanced nutrition: less than body requirements, activity intolerance, and disturbed body image. During the period of caring, the author provided companionship, listening, and caring in order to establish a trust relationship with the patient. The patient was instructed to restore normal diet pattern by strengthened her recognition of the disease, to eat more frequent and smaller meals, and to increase caloric intake gradually. Moreover, the patient was taught to initiate progressive ambulation plans and increase muscle strength exercise to improve activity intolerance. In addition, the patient was encouraged to express her opinion of body image, provided with accurate information. She was able to re-establish a positive body image by understanding her own strengths, appreciating the uniqueness of her body. She was taught to dress up to modify appearance and increase social interaction. It is suggested that an effective treatment plan can involve doctors, nurses, nutritionists, psychologists, and family members. The finding can serve as a reference for caring similar anorexia nervosa patients.