運用中西醫整合照護於一位腦中風合併妄想症病人之護理經驗

The nursing experience with use of combination of Chinese and Western medicine in caring a patient with stroke and delusion

陳俐伶(Chih-Ying Lin) ； 鄧雪妹(Hsueh-Mei Teng) ； 黃淑娟(Shu-Chuan Huang) ； 楊麗慧(Li-Hui Yang)

《中西醫結合護理雜誌》 預刊文章 Pp. 25-35

https://doi.org/10.6211/TTCMNA.NO3-2016-03

摘要

腦血管疾病位居國人十大死因第三位，此疾病不僅危及病人生命安全，更造成病人生活及功能的障礙，現代研究指出約有22%的腦中風病人會出現妄想，並伴隨著情緒及社交功能的損傷。本文係探討一位腦中風病人，因出現妄想內容而與家人發生爭執、生氣、失眠及到處求醫的行為表現。筆者於2014年2月16日至2014年5月2日給予照護，照護期間藉由中醫四診評估（望、聞、問、切），並透過觀察、傾聽、會談、溝通等方式蒐集資料，確立個案有妄想、失眠及便秘等健康問題，於護理過程中結合醫師、中藥師、營養師及心理師等，提供跨團隊照護，藉由醫療影像及監視器畫面，提供個案現實感，介入活動設計轉移個案注意力、透過網路傳輸影像及對話滿足個案需求、協助個案採取自發性的活動及運用五行音樂進行情志照護等，以降低個案妄想的強度；更適時介入穴位按壓實證護理於便秘之照護，筆者更善用足浴、膳食療法等措施，有效改善個案失眠的健康問題，希望藉由照護此個案的護理經驗，提供臨床護理人員在面對照護類似個案之參考，以提昇護理照護品質。

關鍵字

腦中風 ； 妄想症 ； 中西醫整合照護

並列摘要

Cerebrovascular disease rank the third among the top ten leading causes of death in Taiwan. This disease endangers the safety of the patient's life and cause the life and foundation disorder. Some modern research indicates that about 22% Cerebrovascular patient will have delusion with emotion and social functioning damage. This article probes the behavior of a Cerebrovascular patient who dispute with her family, anger, insomnia and everywhere for medication because she has delusions. Author take care the case from Dec. 16th to March 2ed in 2014. During this time we collect data by observing, listening, talking and communicating, then assess the patient with Traditional Chinese Medicine (TCM) to confirm the case has delusions, insomnia, constipation and so on health problem. We combine traditional chinese doctor, traditional chinese pharmacist, dietitian and psychiatrist to provide a cross-functional team care. In order to reduce the delusions of the case, we use picture archiving to provide a sense of reality, intervene activities design to divert attention, satisfy requirement through transfer images and dialog, assist the case take spontaneous activity and use five elements of music to carry out emotional nursing care. Further Author intervene evidence-based nursing of acupressure in the care of constipation and uses footbath and basic nutrition and diet therapy to effectively improve the patient’s insomnia. Through the nursing experience Author hope to provide a reference material for clinical nurses when facing such similar patient to promote the quality of nursing care.

並列關鍵字

Cerebrovascular disease ； delusion ； combination of Chinese and Western medicine in caring