一位急性缺血性腦中風病人接受溶栓治療之照護經驗

本文敘述一位50歲缺血性腦中風男性病人於急診室求診之護理經驗，照護期間為2015年10月18日08:54至10:35，筆者以紐曼適應模式為評估工具，透過身體評估、觀察、會談等方式收集資料，確立個案健康問題依序為身體活動功能障礙、焦慮、潛在危險性傷害等健康問題。面對突如其來的身體活動功能受限，必須在短時間之內作出是否接受血栓溶解劑治療的選擇時，造成病人與家屬產生心理極大的焦慮及壓力。筆者為急診專科護理師，除了提供醫師監督下醫療業務外，運用敏銳的觀察力發現個案及家屬的需求，發揮良好的治療性人際關係。藉由行動醫療資訊系統及網路資源，協助個案及家屬更清楚了解，透過血栓溶解劑治療可獲得的效益及可能帶來的後果。期望藉此照護經驗分享，提供相關同仁照護之參考。

關鍵字

缺血性腦中風；血栓溶解劑；急診護理

並列摘要

This article reveals an experience of caring a 50 -year-old man with ischemic stroke visiting emergency department from 8:54am to 10:35am in October 18, 2015. The author used the Newman System Model of accommodation as a tool for assessment to collect the information by means of physical examinations, observation and communication. The health problems of this case study was determined in the order of functional impairment in physical activities, anxiety, and potential risk of dangerous injury. While the patient and his family faced unexpected events of functional limitation in physical activities, they must make decision about whether or not to receive thrombolytic therapy within a short time. This dilemma can cause extreme anxiety and stress on them. The author is a nursing staff in emergency department, apart from offering medical services under the supervision of doctors, the author also recognized the requirements of the patient and his family with enthusiastic observation to exert beneficial therapeutic interpersonal relationship. Through mobile medical information systems and internet resources, the author helped the patient and his families recognize the acquisitive benefits and potential outcomes from thrombolytic therapy. The author provided this case for the purpose of sharing this experience of nursing care to the relevant personnel.

並列關鍵字

ischemic stroke ； thrombolytic therapy ； nursing care in emergency department

參考文獻

林霏儀、黃繼瑩、鄭榮娟、黃麗華 ( 2015 ) 。提升急性缺血性腦中風病人施打 rt - PA < 60 分鐘比例．新台北護理期刊 , 17 ( 2 ) , 47-56 。 doi:10.6540/NTJN.2015.2.005

郭惠慈、朱以婷、洪芳禎 ( 2009 ) . 提升腦中風病人全關節運動之護理計畫。北市醫學雜誌 , 6 ( 1 ) , 45-58 。 doi: 10.6200/TCMJ.2009.6.1.05

蕭世美、林靜薇 ( 2010 ) . 血栓溶解劑治療急性缺血性腦中風病人之護理 , 榮總護理 , 27 ( 4 ) , 382-387 。 doi:10.6142/VGHN.27.4.382

蕭世美、黃明珠、林靜薇、許立奇 ( 2014 ) . 缺血性腦中風病人使用血栓溶解劑後嚴重度改變量之相關因素研究 , 榮總護理 , 31 ( 2 ) , 176-185 • doi: 10.6142/VGHN.31.2.176

Hsieh, C.Y., Chen, C.H., Chen, Y.C., & Yang, Y.H. K. (2013). National survey of thrombolytic therapy for acute ischemic stroke in Taiwan 2003-2010. Journal of Stroke and Cerebrovascular Diseases, 22(8), 620-627. doi: 10.1016/j.jstrokecerebrovasdis.

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一位急性缺血性腦中風病人接受溶栓治療之照護經驗

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