硬皮症病人面對初次診斷肺結核之照顧經驗

本文描述一位接受免疫抑制劑硬皮症病人，在養護機構的高風險環境下感染肺結核，服用抗結核藥物期間，因為藥物不良反應，加上看護費用負荷與出院轉銜地點等問題，造成身心理的衝擊。照顧期間自2021年12月6日至2022年1月5日及2022年3月1日至4月6日，筆者透過直接照護、觀察及會談等方式評估生理、心理、社會及靈性面向資料後，確立體溫過高、潛在危險性皮膚完整性受損、無望感及社交隔離之健康問題。利用衛教增加病人疾病認知，介紹成功案例增進病人治療信心，協助設定生活目標，運用數位媒體與宗教信仰，提供病人放鬆技巧並增加與重要家人互動，來改善病人健康問題。建議護理人員應增加對於抗結核藥物不良反應識別的敏感度。在照護過程中，除了緩解病人生理不適外，也能增加心理及社會層面評估及照護，更能達到全人照護的目標。

關鍵字

硬皮症；結核病；抗結核藥物不良反應；社交隔離

並列摘要

This paper describes a patient with scleroderma, who received immunosuppressants, and contracted tuberculosis in a high-risk environment such as a nursing home. During the period of anti-tuberculosis treatment, she experienced both physical and psychological impacts due to adverse drug reactions, economic burden of care takers, and location of discharge and transfer issues. FromDecember6, 2021 to January 5, 2022and March 1 to April 6, 2022, her physical, psychological, social and spiritual aspects were assessed through direct care, observations and therapeutic interviews. Her health symptoms included fever, risk for impaired skin integrity, social isolation and hopelessness. In order to build her confidence, the nurse provided health education about tuberculosis to increase awareness; introduce successful cases; and assist in setting life goals. The nurse used digital media and religious power to improve her health problems by providing her relaxation techniques and increasing interactions with important family members. It is recommended that nurses should increase the sensitivity for identification of adverse reactions to anti-tuberculosis drugs. In addition to relieve the patient's physical discomfort during the caring process, psychological, social assessment as well as care should also be improved and hence achieve the goal of holistic care.

並列關鍵字

scleroderma ； tuberculosis ； adverse drug reactions in tuberculosis ； social isolation

參考文獻

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