一位初次腦中風病人合併身體心像紊亂之照護經驗

Nursing Experience for a Patient Diagnosed with Brain Stroke for the First Time with Body Image Disturbance

張秀蓉(Hsiu-Jung Chang) ； 林靖芸(Jing-Yun Lin)

《領導護理》 21卷4期 (2020/12) Pp. 57-72

https://doi.org/10.29494/LN.202012_21(4).0005

摘要

腦血管疾病為十大死因第四位，佔死亡率50.4%／每十萬人口。本文探討一位腦中風病人合併身體心像紊亂之護理經驗，因腦中風導致身體功能及外觀改變，而出現淡漠、哭泣，甚至一度拒絕復健等情緒，故引發筆者書寫動機。照護期間2017年2月23日至3月16日，運用Gordon十一項健康功能模式評估，藉由會談、觀察及身體評估收資料發現個案有身體活動功能障礙、身體心像紊亂及吞嚥障礙等，藉由跨團隊照護執行復健及吞嚥訓練計畫，讓個案能恢復由口進食及基本日常自我照顧能力，協助個案及家屬共同參與復健計畫與活動，以維持身體與社會功能的最佳狀況，同時鼓勵個案表達內心感受及主動參與自我照顧計畫，適時提供疾病相關訊息以減少個案不確定感，以建立正向自我概念及增強疾病照護認知，使個案勇於面對疾病及重新適應日常生活自我照顧，以個案及家屬為中心，提供全人、全家、全隊、全程之照護。期望藉此護理經驗能提供作為日後護理人員照護此類個案之參考。

關鍵字

腦中風 ； 身體活動功能障礙 ； 身體心像紊亂 ； 吞嚥障礙

並列摘要

Cerebrovascular disease comes fourth in the top ten leading causes of death, accounting for 50.4% of the death rate among every 100,000 people. This article discusses a nursing experience for a patient who has brain stroke with body image disturbance. The patient appeared to be in the state of indifference and shed tears due to changes in physical functions and appearance, even once refused rehabilitation that triggered the author's motivation to write this article. The duration of the care was from February 23rd to March 16th, 2017 with Gordon 11 Function Health Patterns applied for evaluation. Through the data collected via interview, observation, and physical assessment, the patient was discovered to have physical impairment, body image disturbance, and dysphagia. Programs of rehabilitation and swallowing training were executed by cross-functional care to recover the patient's oral feeding ability and capability of basic self-care in daily routine as well as to assist the patient and family members to participate in rehabilitation programs and activities in order to maintain the best conditions in terms of physical and social functions. Meanwhile, the patient was encouraged to express personal feelings and participate in the self-care program actively. Information related to the disease was provided timely to reduce the patient's uncertainty in order to establish positive self-concept and increase the knowledge of disease care so the patient courageously faces the disease and readjust self-care in daily routine. Focusing on the patient and family members, providing a whole-person, whole-family, whole-team, and whole-process care program. It is hoped that the aforementioned nursing experience can serve as a reference for other nursing personnel handling similar cases in the future.

並列關鍵字

stroke ； physical impairment ； body image disturbance ； dysphagia

參考文獻

司麗雲、謝素英、曾素美、黃慈心（2017）‧住院復健期腦中風患者吞嚥困難之決定因子探討‧護理雜誌，64（3），43-55。DOI：10.6224/JN.000039

何怡慧、劉秀月、黃純德（2014）‧復建期腦中風病患咀嚼吞嚥障礙盛行率及初步篩檢徵象之探討‧護理雜誌，61（2），54-62DOI：10.6224/JN.61.2.54

吳佩珊、黃惠滿、林婉如（2015）‧腦中風病患吞嚥障礙之評估與護理處置‧高雄護理雜誌，32（3），91-98。DOI：10.6692/KJN-2015-32-3-9

吳思慧、趙千淑、陳香蘭（2016）‧提升腦中風病人吞嚥困難評估及進食指導執行率‧新臺北護理期刊，18（1），69-81。DOI：10.6540/NTJN.2016.1.006

張育儒、胡國琦、姜義彬、莊曜嘉、郭芷霖（2014）‧缺血性腦中風病人住院期間所接受的復健治療量與殘障和死亡風險之關係‧台灣復健醫學雜誌，42（4），191-198。 DOI： 10.6315/2014.42(4)02