照顧一位腦中風個案之護理經驗

A Nursing Experience of Caring a Patient with Ischemic Stroke

顏于芬(Yu-Fen Yan) ； 林美惠(Mei-Hui Lin)

《長庚護理》 33卷1期 (2022/03) Pp. 93-103

https://doi.org/10.6386/CGN.202203_33(1).0009

摘要

本文描述一位48歲女性腦中風個案，因中風導致右側肢體偏癱及合併失語症，個案無法接受疾病帶來的改變，出現情緒低落、無預警落淚情形，護理期間自2018年3月16日至2018年4月12日，運用Gordon十一項健康功能型態評估，確立健康問題為：『身體活動功能障礙、言辭溝通障礙、無望感』。透過復健治療師共同擬定個別性的復健計畫與護理指導，增強肌力與身體平衡，預防關節孿縮，適時給予讚美，提升個案復健動機，增加我照顧能力，改善身體活動功能障礙。在言辭溝通上照護初期運用平板電腦文字擅打，建立良好溝通模式，並教導家屬調整和個案溝通方式，加上透過語言治療計畫，練習口語發聲並配合練唱方式，增加口語表達能力；在對未來無望的改善，照護初期藉由與個案及家屬建立信任關係，以主動關懷、陪伴、傾聽個案內心想法，帶領個案參與病友會，透過相似病友現身說法，讓個案知道自己是可進步，讓個案能重拾信心，再運用家庭支持系統提升其學習力，積極的參與復健面對未來，期望藉此護理經驗能提供護理人員臨床照護之參考。

關鍵字

腦中風 ； 失語症 ； 無望感

並列摘要

This article described the nursing experience of caring a 48-year-old woman with ischemic stroke. Because of ischemic stroke, she had right side paraplegia and aphasia. She was not able to accept the sequela of ischemic stroke. Depressive mood with occasional tears developed. The nursing period was from March 16th to April 12th, 2018. Gordon's Functional Health Patterns were used for overall assessment. The identified health problems included impaired physical mobility, dysarthria, and hopelessness. We set up a personalized rehabilitation plan and nursing guidance with a rehabilitation therapist. Through the plan, her muscle strength, body balance, and joint contracture were improved. We praised accordingly to increase her motivation for rehabilitation. Her self-care ability and activities of daily living were also improved. A tablet was provided at the early phase to assist self-expression. Family members were educated to modify communication methods to facilitate effective communication. In addition, her speech ability was enhanced by training programs, such as singing instruction. To improve her hopelessness, she was accompanied and listened to. Various patient groups were introduced to her, so that experiences from similar patients could be shared. Gradually, she regained her confidence after realizing that her conditions could improve over time. Furthermore, her learning ability was improved through supports from family. She participated in the rehabilitation program actively and was willing to face the future positively. This article can be shared as a reference for caring stroke patients.

並列關鍵字

ischemic stroke ； aphasia ； hopelessness

參考文獻

韓德生、林家瑋、 盧璐、蕭名彥、吳爵宏、梁蕙雯、張凱閔、潘信良、王亭貴、張權維(2016) ‧臺灣腦中風復健治療指引‧台灣復健醫學雜誌，44 (1)，1-9。[Han, D. S., Lin, C. W., Lu, L. Hsiao, M. Y., Wu, C. H., Liang, H. W., Chang, K. V., Pan, S. L., Wang, T. G., & Chang, C. W. (2016). Taiwan guideline for stroke rehabilitation. Taiwan Journal of Physical Medicine and Rehabilitation, 44(1), 1-9.] doi: 10.6315/2016.44(1)01

余鴻文、吳亭芳(2016)‧利用語音輔助溝通系統促進布洛克型失語症者語句產生之學習成效‧特殊教育研究學刊，41 (2)，57-88。[Yu, H. W., & Wu, T. F. (2016). Learning effect of sentence production by a voice output communication aid in patients with broca's aphasia. Bulletin of Special Education, 41(2), 57-88.] doi: 10.6172/BSE.201607.4102003

余鴻文、班迅雷、蔡孟憑、吳亭芳(2016) ‧溝通輔具對於慢性嚴重失語症成人之應用：個案報告‧台灣職能治療研究與實務，12(1)，36-50。[Yu, H. W., Lei, B. S., Tsai, M. P., & Wu, T. F. (2016). The application of augmentative and alternative communication on an adult with chronic severe aphasia: A case report. Journal of Taiwan Occupational Therapy Research and Practice, 12(1), 36-50.] doi: 10.6534/jtotrp.2016.12(1).36

林玟誼、陳秋曲(2015) ‧一位復健期腦中風病人因應疾病過程之護理經驗‧高雄護理雜誌32(3)，55-64。[Lin, W. Y., & Chen, C. C. (2015) .The nursing experience in caring for a stroke patients with coping the disease process during the rehabilitation period. The Kaohsiung Journal of Nursing, 32(3), 55-64. ] doi: 10.6692/KJN-2015-32-3-6

陳玉鈴、蔡玉梅(2017) ‧一位年輕型中風病人之護理經驗‧ 馬偕護理雜誌，11(2) ，82-93。[Chen, Y. L., & Tsai, Y. M. (2017). Nursing care experience for a young patient with stroke. Journal of MacKay Nursing, 11(2), 82-93.] doi: 10.29415/JMKN.201707_11(2).0008