運用羅氏適應模式照護一位細菌性腦膜炎併脊髓炎個案之加護經驗

本文描述一位細菌性腦膜炎併發脊髓炎合併呼吸衰竭之加護經驗，個案突如其來面臨四肢無力、下肢癱瘓，對於未知的未來產生因應能力失調情形，故引發筆者探討之動機，護理時間為2018年4月18日至5月15日，筆者運用羅氏適應模式之生理功能、自我概念、角色功能及相互依賴四大層面為評估架構，確立個案有呼吸道清除功能失效、身體活動功能障礙、個人因應能力失調之健康問題；照顧過程中積極協助個案進行復健運動，增加肌耐力；維持呼吸道通暢，持續進行呼吸訓練，期望能盡早脫離呼吸器，在照護過程中將家屬一同納入照護層面，讓個案感覺被關懷及重視，並提供個案及家屬相關疾病照護知識與技能，提升個案及家屬自我照護能力，並與疾病共存，建議未來照護類似個案時，在疾病復原的過程中，能強化照護者照護能力及個案自我照顧效能，以增進個案與疾病共存之正能量，使其正向面對因疾病而突如其來之失能狀態。

關鍵字

羅氏適應模式；細菌性腦膜炎併發脊髓炎；身體活動功能障礙；個人因應能力失調

並列摘要

The article described a nursing experience from caring for a bacterial meningitis complicated patient with myelitis suddenly encounter weakness of limbs and resulted in ineffective individual coping with the disability. This case motivated the author to explore on the basis of the framework of Roy's Adaptation Model. The nursing period was from April the 18^(th) to May the 15^(th) of 2018. The evaluation structure according to Roy's Adaptation Model includes four levels which are Physiological Function, Personal Conceptualization, Role Functions, and Interdependence. The author conducted the holistic assessment for the patient and identified health problems such as ineffective airway clearance, impaired physical mobility and personal coping dysfunction. During caring period the author proactively assist the patient in rehabilitation exercises to increase muscle endurance; maintain airway patency; continue breathing training, hoping the patient would get out of the respirator as soon as possible, and further improved both patient and his family members' caring level for coexist with the disease. It is recommended when caring for similar cases in the future during clinical caring for recovering period that we strengthening caregiver's caring ability and patient's self-care ability. In order to improve the positive energy for coexist with the disease and the situation of sudden encounter disability when facing disease.

並列關鍵字

Roy's Adaptation Model ； Bacterial meningitis complicated with myelitis ； impaired transfer ability ； personal coping disorder

參考文獻

李克翰、李玉嬋(2014)．脊髓損傷導致身障者的漫長身心復健與生活重建歷程．諮商與輔導，343，57-62。https://doi.org/10.29837/CG

沈佳儀、林邑璁(2016)．細菌性腦膜炎之簡介．臨床醫學月刊，78(4)，226-230。https://doi.org/10.6666/ClinMed.2016.78.4.009

洪淑芬、葉惠慈、楊黛芬、李佳佳、古雪貞(2016)．提升呼吸器依賴病人肺部復健運動執行率之方案．馬偕護理雜誌，10(1)，33-46。https://doi.org/10.29415/JMKN.201601_10(1).0003

鍾旻珊、黃琪津、葉淑玲、林月娥、賀倫惠、陳淑卿(2016)．肺部復健運動介入對使用呼吸器重症病患之成效—系統性文獻回顧．護理雜誌，63(3)，94-104。https://doi.org/10.6224/JN.63.3.94

Wiebe, G. A., Fanella, S., Wrogemann, J., Daymont, C., & Rafay, M.(2016). Diffuse bacterial meningitis and myelitis secondary to a diplococcus organism. Canadian Journal of Neurological Sciences, 43(1), 192-194. https://doi.org/10.1017/cjn.2015.317

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運用羅氏適應模式照護一位細菌性腦膜炎併脊髓炎個案之加護經驗

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