照顧一位抗NMDA受體腦炎病人之護理經驗

本文描述照護一位罹患抗NMDA受體腦炎病人之護理經驗，照護期間自2019年3月7日至2019年4月1日，藉由觀察、身體評估、筆談、傾聽陪伴等方式收集資料，並運用Gordon十一項功能性健康型態評估工具進行歸納、分析、整理後，確立健康問題為身體活動功能障礙、言辭溝通障礙及照顧者角色緊張。過程中，筆者透過關懷、陪伴，建立信賴的治療性人際關係，協同病人與醫療團隊擬訂個別性復健計畫，循序漸進安排復健治療，增進身體活動功能，在言辭溝通障礙部分則先運用平板電腦建立簡單溝通模式，以生活字卡增加口說詞彙量，配合團體治療訓練增加口語表達訓練，照顧者角色方面筆者透過傾聽與引導方式，提升案母對疾病認知、情緒衝突處理技巧並轉介喘息相關資源，找到因應病人情緒的方式，降低長期照顧的擔憂與壓力，安排宗教師關懷，撫慰心靈困惑。鑒於目前國內此疾病照護經驗甚少，臨床初期表徵難以辨別，建議院方製作相關衛教表單，提供一般民眾對疾病有基本認知，並以此個案報告與同儕分享，增加日後醫療人員對於此疾病照護的知能。

關鍵字

NMDA受體腦炎；言詞溝通障礙；照顧者角色緊張

並列摘要

The article describes the author's nursing experience of caring for an anti-NMDA receptor encephalitis patient since 2019/03/07 to 2019/04/01. Observations, physical examinations, conversation by writing and listening were performed during hospitalization and an assessment based on Gordon's-eleven-function-health patterns was done. The major nursing problems included impaired physical mobility, impaired verbal communication and stress of caregiver. The author built a trusting relationship with the patient and the caregiver by caring and company. Customized rehabilitation program was arranged after discussion with the patient and the rehabilitation team to progressively improve physical activity function. For speech communication barrier, first use a tablet PC to establish a simple communication mode; then increase the vocabulary with daily life word cards, and increase oral expression by group therapy. The author provided relevant disease information and skills to deal with emotional conflict to the caregiver. The social worker introduce the program for alternating caring with the professional worker which is recruited by the government. This program would release the stress of long-term caring. Religious teacher also provided psychological support. At present, there is little experience in caring for patient who is diagnosed with this disease in Taiwan. The initial clinical symptoms are hard to distinguish from other diseases. Health educational pamphlet about Anit - NMDA receptor encephalitis should be published to general public by the hospital. The author hopes that this article can be served as a clinical care reference for other nurses taking care of similar cases in the future.

並列關鍵字

NMDA Receptor ； Impaired Verbal Communication ； Caregiver Role Strain

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