一位格林－巴瑞症侯群病人面臨突發性身體活動功能障礙之護理經驗

Nursing Experience of A Patient with Guillain-Barre' Syndrome Who Faced Sudden Onset of Decreased Physical Activity

林小萍(Shiao-Ping Lin) ； 呂沛晴(Pei-Ching Lu)

《馬偕護理雜誌》 8卷1期 (2014/01) Pp. 62-75

https://doi.org/10.29415/JMKN.201401_8(1).0006

摘要

格林-巴瑞症侯群（Guillain-Barré syndrome，GBS）是急性週邊神經發炎導致脫髓鞘病變之疾病，此疾病症狀為急性進行性肢體肌肉無力，合併感覺或自主神經功能失常，甚至伴隨呼吸衰竭發生。本文探討一位40歲男性，因上呼吸道感染引發格林－巴瑞症侯群，引起急性周邊神經病變導致突發性肢體無力之照護經驗。護理期間（2011年2月7日至2月17日）筆者以羅氏護理適應模式為架構，藉由身體評估、觀察、會談等方式收集主客觀資料，發現個案有身體活動功能障礙、知識缺失、焦慮、潛在危險性感染等健康問題。護理過程中，藉由適當翻身擺位，協同復健師制訂復建計畫來改善身體活動功能障礙與預防肌肉萎縮及壓瘡發生；與醫師討論，製作簡易疾病衛教單張，利用淺顯易懂詞句向個案及家屬說明疾病照護注意事項，適時提供諮詢來提升其對疾病認知；與家屬共同制定居家照護計畫，安排轉介至適當醫療機構，以便家屬後續照顧，增強個案支持系統，協助個案以正向態度面對疾病及後續治療，度過生理及心理上之危機，期盼藉由此經驗，讓臨床護理人員日後照顧病人時，除生理上照護外，更能運用心靈層面評估與輔導，適時提供心理支持及建構支持系統，促進個案返家後照護品質，提升人性化關懷於臨床護理業務。

關鍵字

格林－巴瑞症侯群 ； 身體活動功能障礙 ； 焦慮

並列摘要

Guillain-Barre' syndrome is an acute peripheral neuritis leading demyelinating polyneuropathy. Clinical features showed acute progressive muscle weakness with changes of sensation or dysfunction of autonomous nervous system even lead to respiratory failure. This report describes nursing experience of a 40-year-old man who suffered from Guillain-Barre' syndrome after upper respiratory tract infection and then he developed acute peripheral neuropathy and limbs weakness. The nursing period was from 7th to 17th February 2011. The author used Roy's adaptation model as basic model and by physical examination, observation, conversation to collect objective data. His symptoms included limitation of physical activities, insufficient knowledge, anxiety, potential risk of infection and other health related problems. During nursing period, changing patient's position and rehabilitation program made by physiotherapists improved patient's physical activities, and prevented muscle atrophy and pressure sores. After discussing with physician, simple health education pamphlets were made, the author provided explanation of precaution of disease to family members by using simple and easy understandable words. At suitable time, family was given counseling to improve the knowledge of disease. Together with family, home care plan was drawn up. Transfer to suitable medical institution was arranged for follow-up care. The patient's support system was strengthened to assist to face disease and follow-up therapy by positive attitude, and to overcome physical and metal crisis. According to this experience, the author expected when clinical nurses care patients in future, they can apply psychological assessment and assistance in addition to physiological care. At appropriate time, psychological support will be provided, support system will be built to promote care's quality after discharge and humanity care will increase at clinical nursing service.

並列關鍵字

Guillain-Barre' Syndrome ； decreased physical activity ； anxiety