照顧一位出血型腦中風患者吞嚥困難之護理經驗

本文探討一位中風患者，伴隨著半側偏癱及吞嚥困難導致身體心像改變，無法接受及面對外觀改變，而出現負向情緒的照護經驗。照護期間為2019年11月16日至28日，藉由觀察、會談、身體評估等方式收集資料，以Gordon十一項健康功能評估工具，進行身、心、靈、社會整體性評估，確立主要的健康問題有吞嚥功能障礙、身體活動功能障礙、身體心像紊亂等，進而產生強烈的負向思考，不但讓患者缺乏自信與自我價值，影響疾病進展及生活品質，故引發筆者探討此個案之動機。護理過程中，以恢復吞嚥功能為首要，藉由腦中風之專業跨領域團隊合作擬定個別性照護計畫，執行吞嚥訓練運動及飲食指導，儘早順利移除鼻胃管，恢復自我進食及調適身體心向改變的衝擊，以正向及積極的態度面對長期復健活動，提升患者日常生活功能，獲得更好的生活品質，進而回歸正常的社交生活。建議臨床醫療人員能重視腦中風合併吞嚥困難的個案，藉由吞嚥困難的篩檢及計畫性的介入措施，大幅度地減少吸入性肺炎的產生以及重拾由口安全進食的機率以滿足口慾，期望藉此護理經驗，提供日後護理人員照護類似個案之參考。

關鍵字

出血型腦中風；吞嚥困難；身體心像紊亂

並列摘要

This paper presents the nursing experience of a stroke patient with hemiplegia and dysphagia who failed to accept the changes in his body, with corresponding emergence of negative emotions. The nursing period was from November 16 to 28, 2019. Data was collected through observation, interview, and physical assessment. By utilizing Gordon's 11 Function Health Patterns, we performed an integrated evaluation regarding body, mind, spirit, and social functions. The confirmed main health problems were swallowing dysfunction, physical activity dysfunction and body image disturbance, etc. These problems induced strong negative thoughts, not only inducing the patient to lack confidence and self-worth but affect disease progression and quality of life as well. This motivates us to discuss the case. Priority was placed on restoration of swallowing function during the nursing process, while individual care was developed through the cooperation of a professional multidisciplinary team experienced with strokes. Withdrawal of the nasogastric tube, restoration of self-feeding and adjustment of the impact on body image as soon as possible along with swallowing exercises and dietary guidance were all implemented. The patient could then confront long-term rehabilitation activities with a positive attitude, improve the activities of daily living, obtain a better quality of life and return to normal life. Clinical medical staff should pay more attention to stroke patients with dysphagia. Through dysphagia screening and planned interventions, the incidence of aspiration pneumonia could be significantly reduced as well as the chance of eating safely by mouth regained to satisfy the appetite. We hope to provide this nursing experience as a reference for nursing staff to take care of similar cases in the future.

並列關鍵字

Intracranial hemorrhagic stroke ； dysphagia ； body image disturbed

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