照顧一位川崎氏症學齡期病童的護理經驗

本文為探討一位6歲女童罹患川崎氏症之護理經驗。個案因口腔黏膜破損導致口腔疼痛拒絕進食，皮膚脫皮及全身皮疹而哭鬧難受，案母又因對疾病照護、治療及預後認知不足而感到緊張不安，引發筆者探討之動機。於2021年3月10日至2021年3月14日護理期間經由觀察、傾聽、身體評估、會談及溝通法等技巧收集資料，並運用Gordon十一項健康功能型態評估，確立主要健康問題有：口腔黏膜障礙、皮膚完整性受損、照護者角色緊張等三項。針對上述問題，使用卡通影片給予個案學習口腔清潔，也利用個案喜愛的玩偶進行示範與練習，增加個案對刷牙的興趣，減輕口腔疼痛的不適感；衛教案母保持個案皮膚乾燥，並提供病童服，增加個案的舒適度；適時給予案母非語言安撫，提供案母川崎氏症照護及居家照護注意事項，以增加出院後的照護知識減輕照護壓力。建議醫療院所當發現確診為川崎氏症時，除了提供完整的診斷治療照護流程，亦可運用個案管理模式進行持續性的追蹤管理，持續性觀察案母個案返家後居家照顧情形與回診追蹤落實性。期望透過分享照護過程讓未來在照護此類兒童時有參考的護理經驗，以增加照護品質。

關鍵字

川崎氏症；口腔黏膜障礙；皮膚完整性受損；照護者角色緊張

並列摘要

This article discusses the nursing experience from caring for a 6-year-old girl with Kawasaki disease. The patient cried and felt uncomfortable because of oral pain, her skin was peeling off, and she refused to eat due to the damage of the oral mucosa. Her mother was nervous due to insufficient knowledge of disease care, treatment and prognosis, which triggered the motivation for the author to write the case report. During the nursing period from March 10th to 14th, 2021, data were collected by observation, listening, physical assessment, interview and communication, as well as applying Gordon's 11 Functional Health Assessment to identify the main health issues as: oral mucosal disorders, impaired skin integrity, and caregiver role stress. In response to the above problems, cartoons were shown to teach the case about oral hygiene, and the case's favorite doll was also used for demonstration and practice, which elevate the case's interest in brushing teeth and relieved the discomfort of oral pain; the health education nurse keeps the patient's skin dry and provides sick children clothing to improve the pediatric patient's comfort. Promptly provide the mother non-verbal comfort, to prepare the mother with Kawasaki disease care and home care precautions to increase the nursing knowledge after discharge and reduce the care pressure. It is recommended that when a medical institution has diagnosed patient with Kawasaki disease, apart from providing a complete diagnosis, treatment and care process, it can also apply the case management model for continuous tracking and management, for continuously observing the home care situation and follow-up with the caregiver after returning home as well as implementation of follow-up visits. It is hoped that by sharing this care process, it will serve as a reference for caring for such patients in the future, so as to improve the quality of care.

並列關鍵字

Kawasaki disease ； oral mucosal disorders ； impaired skin integrity ； caregiver role stress

參考文獻

李如芳（2020）．一位急性骨髓性白血病學齡期兒童接受骨髓移植前之護理經驗．腫瘤護理雜誌，20(1)，77-86。 https://doi.org/10.6880/TJON.202006_20(1).06

李俞潔、辛文蕙、張秀美（2017）．一位甲狀腺癌病童接受氣管造口與鼻胃管後身體心像紊亂之護理經驗．馬偕護理雜誌，11(2)，71-81 。 https://doi.org/10.29415/JMKN.201707_11(2).0007

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