- 期刊
一位初診斷紅斑性狼瘡併發狼瘡腎炎學齡期兒童之護理經驗
Nursing Care Experiences for a Systemic Lupus Erythematosus Child Suffering from the Complication Lupus Nephritis
摘要
本文探討一位學齡期兒童初診斷紅斑性狼瘡併發狼瘡腎炎之護理經驗，照護期間為2017年3月8日至3月25日，運用兒童的生理、心理、認知發展等行系統性身體評估，另以觀察、會談、閱讀病歷、直接照護等方式收集資料，確立個案的主要健康問題包括體液容積過量、身體心像紊亂、照顧者角色緊張。護理期間密切監測體液變化，指導水份攝取重點，並讓個案有參與權，採取同理心、陪伴、主動傾聽建立良好護病關係，鼓勵個案及其主要照顧者表達對身體外觀改變及疾病所帶來的情緒壓力；另透過服飾或配件的搭配，減少個案因外觀改變所帶來的衝擊；提供案母相關護理指導，以提升主要照顧者在預防感染、降低合併症發生之照護能力；並照會營養師給予飲食的指導與建議，進而降低其不安及擔憂的緊張情緒。護理過程中促使個案與其照顧者以正向態度看待疾病及治療，提升其自信心與自我價值，達到最佳健康狀態。希望藉由本篇報告分享，期能作為同仁日後照顧類似病童之參考。
並列摘要
This article explored the experience of nursing a school-age child with a primary diagnosis of lupus erythematosus complicated by lupus nephritis. The period of nursing care was from 8^(th) to 25^(th) March 2017. The nurse performed a systematic assessment of the child's physical, psychological, and cognitive development. In addition, data were collected by observation, interviews, chart review, and direct care. After completing the assessments, the patient's health-related problems were identified as excess fluid volume, body image disturbance, and caregiver role strain. Over the period of nursing care, the nurse carefully monitored changes in the patient's body fluid volume and instructed the patient on how to manage her volume of liquid intake. Additionally, the nurse involved the patient in decision making. Overall, the nurse-client relationship was based on empathy, active listening, providing companionship, and offering alternatives from which to choose. The patient was encouraged to express her thoughts and feelings caused by changes in body image and stress. The caregivers were likewise encouraged to discuss their perceptions and received instruction on daily nursing skills for this patient in order to prevent infections and complications. In the course of nursing, the patient and her caregivers were encouraged to take a positive attitude towards medical treatment and the disease, to enhance their self-confidence and self-worth, and to achieve optimal health. It is hoped that this report will be shared as a reference for colleagues taking care of similar cases in the future.