應用概念構圖於一位反覆腸胃道出血老年患者之照護經驗

Nursing Experience of Using Concept Maps for Evaluation of Recurrent Gastrointestinal Bleeding in an Elderly Patient

王主音(Chu-Yin Wang) ； 楊惠卿(Hui-Ching Yang)

《高雄護理雜誌》 35卷2期 (2018/08) Pp. 116-128

https://doi.org/10.6692/KJN.201808_35(2).0011

摘要

本文描述一位反覆腸胃道出血老年個案之照護經驗，護理期間為2015年11月23日至11月26日，筆者運用概念構圖呈現系統性評估，透過觀察、傾聽、身體評估、會談及病歷資料等方式收集資料，確立個案有「現存性傷害」、「健康維護能力改變/返家自我照顧需求」、「潛在危險性跌倒」、「焦慮」四項主要護理問題。針對現存性傷害問題，予以密切監測生命徵象變化及觀察再出血現象，配合醫囑執行給藥治療，以解決個案的身體不適症狀。在護理過程中，運用主動關懷、陪伴以及同理心技巧，幫助個案接受與適應疾病治療。在恢復期使用食道靜脈曲張出血指導單教導個案與家屬有關返家的飲食原則與自我觀察身體的症狀，以提升個案返家自我照顧能力。本文藉此分享概念構圖方式照護一位反覆腸胃道出血的老年個案之護理經驗，期盼能提供臨床護理人員照護此類患者之參考，以提升護理專業照顧品質。

關鍵字

概念構圖 ； 腸胃道出血 ； 護理

並列摘要

This study discusses the nursing experience of an elderly patient with recurrent gastrointestinal bleeding during the period of nursing care from 23.11.2015 to 26.11.2015. The author used the concept maps of systematic physical assessment. For the patient information, the collected data was through observation, listening, physical assessment, interview, and medical records. After assessment, it was found that the patient had four main nursing problems: 1.existential injury, 2.altered health maintenance - related to lack of gastroesophageal bleeding knowledge, 3.risk of falling, and 4.anxiety. According to the nursing problem of existential injury, it was concentrated on monitoring of patient vital signs and bleeding condition, and followed orders giving drug therapy. It aimed to reduce the physical symptoms of feeling unwell. During the nursing care, the author used active care, companionship and empathy skills to help the patient accept and adopt treatments. In recovery, the author used an esophageal variceal bleeding care leaflet to improve both patient and family home-care knowledge. The leaflet included diet and self-observation symptoms, and aimed to promote patient self-care ability. This study shares the nursing experience on using concept maps for evaluation of recurrent gastrointestinal bleeding in an elderly patient. The authors hope it can provide a reference when caring for similar cases and it can improve professional nursing care quality.

並列關鍵字

Concept mapping ； Gastrointestinal bleeding ； Nursing care

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