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照顧一位胸腺瘤切除術後引發肌無力危象病人之加護經驗

The Experience of Caring for a Thymectomy Patient with Myasthenic Crisis in an Intensive Care Unit

摘要


本文係描述一位罹患肌無力症病人,在胸腺瘤切除術後併發肌無力危象,導致呼吸衰竭入住加護中心之護理經驗。護理期間自2013年07月10日至07月19日,筆者藉由觀察、會談、身體評估及實際照護等方式,以紐曼健康系統模式收集及評估個案,確立其健康問題有:呼吸道清除功能失效、活動無耐力及妥協性家庭因應能力失調。在多團隊的合作下病人,成功脫離同時呼吸器,並增加四肢肌肉強度及活動耐受度;協助家屬參與治療過程,強化家庭成員間的支持功能與情感連結,進而調適疾病所帶來的經濟與家庭衝擊;另外,協同社工師、支持團體及肌無力關懷協會,給予個案適當的心理與社會支持,藉此協助病人順利渡過危機維護健康。

並列摘要


This article describes nursing experience on taking care of a post thymectomy patient who experienced a myasthenic crisis that lead to respiratory failure in an intensive care unit. Data was collected from July 10 to 19, 2013, through observation, conversation, physical examination, and actual care based on the Neuman System Model. The nursing diagnosis of the patient included ineffective airway clearance, activity intolerance, compromised ineffective family coping. The ultidisciplinary collaboration helped the patient successfully weaned off the ventilation and regained muscle strength to breathe and move limbs. The family’s participation in the process of treatment strengthened both the patient and family’s communication, coping, adaptation of the disease and financial burden. Additionally, the social worker, support groups and the Myasthenia Gravis Association provided psychosocial support help the patient cope with the impacts of the disease.

參考文獻


邱豔芬(2006).胸腹手術後病人的肺部復健.護理雜誌,53(5),5-12。doi:10.6224/JN.53.5.5
張美玉(2013).脫離準備度之概念分析.榮總護理 ,31(1),95-102。doi:10.6142/VGHN.30.1.95
Chen, Y. T., Shih, F. J., Hayter, M., Hou, C. C., & Yeh, J. H., (2013). Experiences of living with myasthenia gravis: A qualitative study with Taiwanese people. Journal of Neuroscience Nursing, 45(2), 3-10. doi:10.1097/JNN.0b013e31828291a6
Chen, Y. T., Chang, Y., Chiu, H. C., & Yeh, J. H., (2011). Psychosocial aspects in myasthenic patients treated by plasmapheresis. Journal of Neurology, 258(7), 1240-1246. doi:10.1007/s00415-011-5913-4
Chu, X. Y., Xue, Z. Q., Wang, R. W., & Tan, Q. Y., (2011). Predictors of postoperative myasthenic crisis in patients with myasthenia gravis after thymectomy. Chinese Medical Journal, 124(8), 1246-1250. doi:10.3760/cma.j.issn.0366-6999.2011.08.023

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