照顧一位腦中風合併吞嚥困難病人之護理經驗

目的：腦中風病人約有55％會有吞嚥障礙。本篇報告描述一位因頭暈、胸悶、嘴巴歪斜、無法起身導致右側中大腦動脈梗塞性腦中風合併吞嚥困難之復健個案的照護經驗。方法：護理期間自2013年8月6日至9月9日，筆者經由會談、觀察、身體評估及Gordon十一項功能性健康評估等方式收集與分析資料，發現主要護理問題有吞嚥障礙、身體活動功能障礙、言詞溝通障礙與調適障礙。結果：在整個照護過程中，筆者主動關懷並實際參與照護，針對個案的實際需求，提供適時的關心與協助，透過與個案、家屬共同討論並擬定個別性、持續性的護理措施，並與復健治療師、語言治療師共同討論復健計畫，透過物理治療與職能治療增加個案患側的活動度，及吞嚥訓練，出院前可以拔除鼻胃管，成功讓個案重獲由口進食，享受吃的權利，恢復部分自我照顧能力，拾獲自信心，更積極參與復健。結論：期望此護理經驗能提升護理人員在腦中風合併吞嚥困難病人之照護。

關鍵字

腦中風；中風；復健治療；吞嚥困難

並列摘要

Purpose: There is about 55% chances of swallowing difficulty would be found on the patient who had stroke. The purpose of this study is to describe a nursing experience of taking care of a patient who had the symptoms of dizziness, chest tightness, wry lips, unable to get off from the bed, and finally was diagnosed with right middle cerebral artery territories infarction with swallowing difficulty. Methods: From August 6th to September 9th in 2013, I found that the patient have problems of dysphagia, body moving dysfunction, communicatiion dysfunction and adjustment disorder, after observation, estimations with Gordon 11 Function Health Patterns, and interview with this patient. Results: I participated entirely into the whole treatment course. The rehabilitaion plan was set by discussing with the patient and her family members, considering the actually requirement. Besides, physical therapist and language therapist were also involved in the treatment plan. The avtivity of affected side and swalloing ability improved much after physical and occupational therapy were applied. The patient's NG tube was finally removed, and the patient could have food orally and smoothly. Also, she participated the rehabilitation treatment much aggressively due to rebuilt self-confidence and the regained ability of self-care. Conclusion: Hoping that we could enhance the quality of care on CVA patient with swalling difficulty.

並列關鍵字

Cerebrovascular Accident ； CVA ； stroke ； rehabilitation treatment ； dysphagia ； swallowing difficulty

參考文獻

衛生福利部（2014，9月）．民國102 年主要死因分析．取自http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=5150

Google Scholar

Martino,R.,Silver,F.,Teasell,R.,Barle y,M.,Nicholson,G.,Streiner,D.L.,et al：The Toronto Bedside Swallowing Screening Test(TOR-BSST): Development and Validationofa Dysphagia Screening Toolfor Patients WithStroke. Stroke 2009;40:555-561.