- 期刊
肌萎縮性側索硬化症病人之護理經驗
Nursing Experience of an Amyotrophic Lateral Sclerosis Patient
摘要
本文旨在敘述一位72歲肌萎縮性側索硬化症病人，因意識改變、呼吸衰竭，經急救後入加護病房治療之護理經驗。照護期間為2009年9月13月至10月至2日，運用Roy適應模式為評估架構，經由直接照護、身體評估、觀察、病程紀錄及與家屬會談等方式進行相關資料收集，確立病人主要健康問題有：一、呼吸道清除功能失效／肺部感染導致痰液增加及無法有效自咳；二、身體活動功能障礙／神經肌肉功能障礙致肌肉力量減少；三、無望感／不瞭解疾病進展之事實與身體功能退化需依賴他人。於住院期間提供氧氣治療及胸腔物理治療；協助採取舒適臥位及翻身擺位，訂定及執行肢體復健計畫；給予心理支持、運用同理心，建立治療性人際關係，強化家庭系統，增加日常生活控制感等護理措施後，結果病人能執行有效咳嗽且維持正常氧合濃度，生命徵象穩定；關節無攣縮變形、皮膚無壓瘡發生；能透過醫療團隊與家屬共同協助病人了解疾病及預後，鼓勵表達內心感受並配合治療，漸進適應疾病所帶來的改變，期許透過個別性與整體性之護理，提升病人及家屬生活品質。
並列摘要
This article describes nursing experiences with an amyotrophic lateral sclerosis (ALS) patient who was hospitalized from September 13 to October 2 2009 in an intensive care unit (ICU) following emergency medical care. The Roy Adaptation Model was used as the assessment framework. Pertinent data were collected by physical examination, observation, disease progression history and family member interviews. The patient main health problems were confirmed to be as follow: respiratory clearance function failure, a physical activity function barrier, and hopelessness. Oxygen and chest physical treatment were provided during the hospitalization period. A comfortable supine position was arranged and turning was assisted; furthermore, a limb rehabilitation program was scheduled and executed. The patient was supported psychologically in order to establish a therapeutic interpersonal relationship, to strengthen the family structure, and to improve daily life control. As a result, the patient was able to cough effectively, maintain normal oxygenation and his vital signs were stabilized. There were no distortions in joint shape and no skin pressure ulcers. The medical team and his family members worked together to help the patient understand the disease and prognosis and to encourage the patient to express his inner feelings. They also cooperate in terms of treatment and help him adapt to the changes brought about by the disease. It is believed that the quality of life of the patient and of his family were improved by the individual and overall nursing care.