照顧一位腦中風個案合併吞嚥障礙之護理經驗

根據衛生福利部2019年資料顯示，腦血管疾病佔十大死因中第四位，死亡率51.6%。本文描述一位復發性腦中風之74歲女性，因左側無力、嗜睡且易嗆咳放置鼻胃管，住院初期無法接受肢體偏癱及放置鼻胃管之事實，一度拒絕復健，故引發筆者探討動機。護理期間自2020年5月5日至 16日，筆者以Gordon十一項功能性健康型態之評估為架構，運用直接照護、觀察、會談、身體評估等方式進行資料收集，發現個案有吞嚥障礙／與神經肌肉控制失調有關、身體活動功能障礙／與中風後肢體肌肉力量減弱，部分日常生活須他人協助有關、身體心像紊亂／與身體功能及外觀改變有關等健康問題。照護期間協同復健團隊及家屬，共同鼓勵個案參與治療計劃，介紹及分享成功案例，增進對疾病預後信心，教導案女及協助個案吞嚥及復健技巧，運用關懷、同理心及傾聽個案內心想法，紀錄患肢復健變化，引導正向的態度面對，使其逐漸恢復左側肌力，改善身體心像紊亂，早日回歸日常生活及技能。期盼藉此護理經驗分享，提供臨床護理工作照護此類病人之參考。

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

In 2019, data from the Ministry of Health and Welfare suggested that cerebrovascular diseases accounted for the fourth of the top ten leading causes of death, with a mortality rate of 51.6%. This study presents a case of a 74-year-old woman with recurrent stroke, who in the early stage of hospitalization, refused to accept the fact that she had hemiplegia of the limbs and intubation of a nasogastric tube due to weakness on the left side of her body, lethargy, and a strong gag reflex. The patient's condition motivated the author to establish the discussion. Nursing period is from May 5 to 16, 2020, following Gordon's Eleventh Functional Health Assessment, the author applied direct care, observation, interviews, physical assessment, and so on to collect data. The patient was diagnosed with dysphagia associated with neuromuscular disorders, impaired physical mobility associated with post-stroke weakened muscle strength, dependent lifestyle, compromised self-perception associated with the changes of physical function and appearance, and additional issues due to health care. During care, the author cooperated with the rehabilitation team and family members to encourage the patient to participate in the treatment plans. Successful cases were introduced to the patient to boost confidence in the prognosis of the disease. Through education, assist patient in swallowing and rehabilitation skills; utilize care, empathy, listening to the patient; documentation of physical rehabilitation regarding the affected limb, and guidance towards a positive attitude. The patient's left muscular condition gradually restored, the negative view of self-perception was improved, and return to normalcy as soon as possible. The author hopes this experience can provide reference for clinical nursing professionals when performing care on similar type of patient.｜In 2019, data from the Ministry of Health and Welfare suggested that cerebrovascular diseases accounted for the fourth of the top ten leading causes of death, with a mortality rate of 51.6%. This study presents a case of a 74-year-old woman with recurrent stroke, who in the early stage of hospitalization, refused to accept the fact that she had hemiplegia of the limbs and intubation of a nasogastric tube due to weakness on the left side of her body, lethargy, and a strong gag reflex. The patient's condition motivated the author to establish the discussion. Nursing period is from May 5 to 16, 2020, following Gordon's Eleventh Functional Health Assessment, the author applied direct care, observation, interviews, physical assessment, and so on to collect data. The patient was diagnosed with dysphagia associated with neuromuscular disorders, impaired physical mobility associated with post-stroke weakened muscle strength, dependent lifestyle, compromised self-perception associated with the changes of physical function and appearance, and additional issues due to health care. During care, the author cooperated with the rehabilitation team and family members to encourage the patient to participate in the treatment plans. Successful cases were introduced to the patient to boost confidence in the prognosis of the disease. Through education, assist patient in swallowing and rehabilitation skills; utilize care, empathy, listening to the patient; documentation of physical rehabilitation regarding the affected limb, and guidance towards a positive attitude. The patient's left muscular condition gradually restored, the negative view of self-perception was improved, and return to normalcy as soon as possible. The author hopes this experience can provide reference for clinical nursing professionals when performing care on similar type of patient.

並列關鍵字

stroke ； impaired physical mobility ； dysfunction of physical activity ； bodyimage disturbance ； dysphagia｜stroke ； impaired physical mobility ； dysfunction of physical activity ； bodyimage disturbance ； dysphagia

參考文獻

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張耿維、陳怡璇、林蓓宜、黃光聖（2016）．腦中風急性後期患者物治療介入之成效．南臺灣醫學雜誌，12(2)，61-68。https://doi.org/10.6726/MJST.201612_12(2).0001

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