照護一位多重用藥導致步態障礙老人之護理經驗

本篇是一位82女性，因老年共病症使用多達17藥物導致步態障礙，成功整合藥物之照護經驗。照護期間自2020年5月5日至8月27日，共計9次老年醫學科門診面訪及10次的電訪，運用周全性老年評估、觀察、會談及病歷查閱等收集資料，確認個案有四項健康問題：服藥不遵從、高危險性跌倒、營養狀況少於身體需要及無望感等。筆者協同醫師、個案及家屬三方進行藥物整合，順利降為3種必需用藥，並配合時間標註藥盒管理提升服藥遵從性。此外，運用彈力帶進行下肢肌力運動、踮腳站立訓練平衡；與家屬檢視居家環境後加裝浴廁扶手降低跌倒；衛教保持口腔濕潤技巧及準備軟質食物，從「吃得下」搭配少量多餐達到均衡飲食，進而矯正低血鈉改善身體無力。經措施後個案行走步態穩定，逐漸增加社交活動。建議多重用藥個案都能及時獲得跨團隊整體性照護降低併發症。藉此護理經驗分享，落實個案及家屬全人照護，達到老人延緩失能之目的。

關鍵字

多重用藥；周全性老年評估；步態障礙；營養狀況少於身體需要；無望感

並列摘要

In this article, an 82-year-old woman who used up to 17 drugs for age-related comorbidities, which caused gait impairment, had the drugs successfully integrated via nursing experience. During the care period, from May 5 to August 27, 2020, nine outpatient interviews and 10 telephonic interviews were conducted with the patient. Data were collected through a comprehensive geriatric assessment, observations, interviews, and a medical record review. As a result, four health problems were identified, including non-compliance with medication, high risk of falls, nutritional status less than physical needs, and hopelessness. The author cooperated with the physicians, patient and family members to integrate the drugs, and successfully reduced the necessary drugs to three kinds. To improve medication compliance, the patient's cooperation with time-marking pill box management was suggested. Lower limb muscle exercises with elastic bands and tiptoe standing training balance were also recommended. After the home environment was reviewed with family members, bathroom handrails were installed to reduce falls. Furthermore, keeping the mouth moist and small and frequent meals with soft foods to achieve a balanced and good diet and to improve general weakness and hyponatremia were encouraged. After the nursing intervention, the patient's walking gait was stable, and social activities gradually increased. Results suggest that cross-team holistic care in a timely manner can reduce complications in patients with polypharmacy. By sharing nursing experiences, whole-person care of the patients and their families can be implemented to delay disabilities among older adults.

並列關鍵字

polypharmacy ； geriatric assessment ； gait disorder ； nutritional status less than body requirements ； hopelessness

參考文獻

卜心怡、游雅梅（2017）‧照顧一位腦中風後無望感患者之護理經驗‧榮總護理，34（1），49-56。https://doi.org/10.6142/VGHN.34.1.49

杜彗寧、張家銘、周玟觀、葉鳳英（2017）‧老年人之用藥問題‧臺灣老年醫學暨老年學雜誌，12（1），1-19。https://doi.org/10.29461/TGG.201702_12(1).0001

吳詩韻、吳靜宜、陳明翰、曹彥博、李士元（2018）‧修格蘭氏症候群患者的口腔照護‧臨床醫學，82（1），421-424。https://doi.org/10.6666/ClinMed.201807_82(1).0075

吳培文、柯澐蓁、何清幼、余文瑞（2020）‧老年人預防跌倒的運動處方‧北市醫學雜誌，17（1），20-30。https://doi.org/10.6200/TCMJ.202003_17(1).0003

林孟屏、陸鳳屏（2019）‧住院中周全性老年評估之應用與實證‧內科學誌，30，2-6。https://doi.org/10.6314/JIMT.201902_30(1).02

主題瀏覽