護理之家重度失智症合併營養不良個案之照護經驗

Nursing Experience of a Severe Dementia Patient with Malnutrition in Home Care Facility

蕭琇霞(Hsiu-Hsia Hsiao) ； 陳雅芳(Ya-Fang Chen) ； 陳頌云(Sung-Yun Chen) ； 蔡衣帆(Yi-Fan Tsai) ； 陳淑暖(Shu-Nuan Chen)

《北市醫學雜誌》 預刊文章 Pp. 1-13

https://doi.org/10.6200/TCMJ.202012/PP.0001

摘要

本篇描述一位住在護理之家重度失智合併營養不良之81歲女性個案之護理經驗。照護期間為2018年2月8日至3月31日，經由Beck及Heacock針對失智症個案提出生理、情緒、認知及社會評估分析後，確立個案主要健康問題依序有：（一）營養狀況少於身體所需與進食量不足有關；（二）潛在危險性跌倒與平衡障礙有關；（三）照顧者角色緊張與案夫不了解失智症病程發展及缺乏照護技巧有關。在護理過程中與個案及家屬建立信任護病關係，藉由會診語言治療師進行吞嚥訓練、採少量多餐，讓個案進食量可以增加維持營養平衡；進行跨專業團隊與家屬召開醫病溝通會議，共同擬定並執行復健活動，讓個案能維持部分日常生活能力及增加其肌力，並教導案夫照顧失智症的相關知識與餵食技巧，陪同個案參與機構舉辦的活動，運用Kingston照顧者壓力量表（Kingston Caregiver Stress Scale, KCSS）評分其總分由35分降為20分，減輕案夫焦慮。期望藉由此護理經驗提供臨床照顧重度失智合併營養不良者之參考依據，以提升其照護及生活品質。

關鍵字

重度失智 ； 營養狀況少於身體所需 ； 潛在危險性跌倒 ； 照顧者角色緊張

並列摘要

This case report describes the nursing experience of an 81-year-old woman with severe dementia and malnutrition living in a nursing home. The patient received nursing care from February 8 to March 31, 2018. We applied the Beck and Heacock's model for physiological, emotional, cognitive and social assessments in this patient and her caregiver, and identified three major health problems: (1) nutrition less than body requirements related to an insufficiency of food intake; (2) potential fall hazards related to balance disorder; (3) strain of caregiver role related to the lack of an understanding of her husband in the development of dementia and care skills. Trust and nurse-patient relationship were established with the case and her family during the nursing process. By consulting a speech therapist for swallowing training and small meals, the patient had increased the amount of food intake and a nutritional balance was thus maintained. The medical cross-discipline professional team and her caregiver hold medical communication meetings to develop and implement the rehabilitation activities plans together, and as a result the patient could maintain part of her daily living ability and had increased her muscle strength. We taught the caregiver about the knowledge and feeding skills of dementia and encouraged him to accompany the patient participating in activities of the nursing home. Assessment of the caregiver using the Kingston Caregiver Stress Scale (KCSS) found a decrease of anxiety level from 35 to 21 points. We hope to provide a reference for the care of the patients with severe dementia and malnutrition, and improve the quality of care and life for patients with this nursing experience.

並列關鍵字

severe dementia ； nutrition less than body requirements ； potential fall hazards ； caregiver role strain