照顧一位初次腦中風個案之護理經驗

A Nursing Care Experience of a First Time Stroke Patient

利怡慧(Yi-Hui Li) ； 陳淑華(Shu-Hwa Chen) ； 周嫚君(Man-Chun Chou) ； 陳秀偵(Shiu-Chen Chen)

《長庚護理》 29卷3期 (2018/09) Pp. 431-441

https://doi.org/10.6386/CGN.201809_29(3).0009

摘要

本文敘述一位初次腦中風導致吞嚥困難、肢體無力、構音困難之護理經驗。照護期間為2015年12月3日至16日，透過傾聽、觀察及身體評估等方式，運用Gordon十一項功能性健康型態評估收集與分析資料。確立健康問題為吞嚥障礙、身體活動功能障礙、言辭溝通障礙、知識缺失及身體心像紊亂，運用跨領域團隊合作，與個案及家屬共同擬定照顧計畫，指導個案口腔運動、吞嚥及進食技巧、平衡訓練、肢體活動訓練及構音技巧等，並探究不按時服降血壓藥原因及面對疾病所致的心理衝擊主動了解病人內心感受及需求，鼓勵參與自我照顧計畫，提供相關訊息，改變中風前高血壓認知，及協同家人的支持，激發病人維持復健的動力，重新面對中風的影響，建立正向自我概念及疾病照護認知。期望藉此護理照護經驗日後能提供臨床照護之參考。

關鍵字

腦中風 ； 吞嚥困難 ； 護理經驗

並列摘要

This article described a nursing care of a first time stroke patient suffering from dysphagia, weak limbs, and dysarthria. From December 3 to 16, 2015, the author adopted Gordon's 11 functional health pattern assessment to collect and analyze the data of the patient with the strategies of interview, observation, and physical assessment. The confirmed major physical difficulties were impaired swallowing, physical mobility and verbal communication, as well as deficient knowledge, and disturbed body image. By conducting multi-disciplinary cooperation, the author established a caring plan with the patient and the family. First, the author instructed the patient in oral motor exercise, skills of swallowing and eating, balance and limb activity training, as well as articulation skill. Second, the author looked into the reason of the patient not taking medications on time and the psychological impact when he faces the illness, so that the author could understand how the patient felt and what were needed, and encouraged the patient participate in self-care plan. Furthermore, the author provided the patient with relevant information to change his understanding of hypertension. With the support and cooperation from the family, the author had promoted the patient's motive for rehabilitation, and the patient began to re-confront the impact of stroke. The experience can be a reference for similar nursing cares in the future.

並列關鍵字

stroke ； dysphagia ； nursing care

參考文獻

台灣腦中風學會(2015)．腦中風危險因子防治指引：高血壓2015 ．取自：http://www.stroke.org.tw/guideline/guideline_index.asp[Taiwan Stroke Association. (2015). Brain stroke risk factors prevention and treatment guidelines: Hypertension 2015. Retrieved from http://www.stroke.org.tw/guideline/guideline_index.aps]

邱明發、顏兆熊(2011)。缺血性腦中風急性期後之處置。當代醫學。457，851-857。

陳建志、陳亮宇、張馨丰、鄒永恩、陳登郎(2015)。以急性單側聲帶麻痺為初始表徵之外側延髓梗塞。台灣耳鼻喉頭頸外科雜誌。50(3)，181-185。

陳夏蓮、蔡仁貞(2012)。症狀經驗、病因解釋與治療遵從行為—以高血壓病人為例。護理雜誌。59(1)，5-10。

詹淑雅、劉芹芳、金繼春(2011)。身體心像紊亂之概念分析。新臺北護理期刊。13(1)，63-72。