照顧一位顱內出血患者的護理經驗

Nursing Experience with an Intracranial Hemorrhage Patient

林幸雅(Shing-Ya Lin) ； 吳英旬(Ying-Hsun Wu)

《The Changhua Journal of Medicine》 9卷s期 (2004/12) Pp. 277-282

摘要

背景及目的：顱內出血是腦血管疾病的一種，腦血管疾病為台灣地區十大死因第二名，此類患者發病後若合併有身體功能、語言障礙則可能引發生理、心理、社會、靈性…各層面的問題。
方法：筆者以主護護士的角色參與、觀察照護，並採用Gordon十一項健康功能型態評估一位74歲因顱內出血出現右側癱瘓併表達性失語症男性患者的主客觀資料。
結果：個案有言辭溝通障礙、知識缺失、自我照顧能力缺失等問題。於評估後與患者、家屬共同擬定護理措施並執行，包括：1．使用輔助器具訓練日常生活活動2.運用肢體語言、圖片、字卡等方式達有效溝通3給予高血壓相關之日常照護、飲食、服藥及併發症衛教等護理。
結論：此次的護理經驗中促進患者和家屬之互動及利用純熟的專業護理增進彼此的信任感，對於建立良好的護病關係是有益的。建議長期肢體障礙患者應轉介復健科作持續性治療，失語問題則需提供家屬相關的認知指導，並於出院前協助重建患者與主要照顧者甚至家庭成員的溝通模式。

關鍵字

顱內出血 ； 失語症 ； 癱瘓

並列摘要

Background and purpose: Cerebrovascular diseases are the second leading cause of death in Taiwan. One form of cerebrovascular disease is intracranial hemorrhage. These patients often suffer from disability and aphasia, and have physical, psychological, social, and spiritual problems.
Method: The authors collected objective and subjective information from a 74 year-old male with an intracranial hemorrhage having right-sided paralysis and expressive aphasia. Data was collected using Gordon's Eleven Functional Health Patterns as a framework.
Results: Patterns identified included communication disturbance, insufficient information, and lack of self-care ability. The authors used point of care equipment to assist with daily activities. The patient was communicated with by body language, pictures, and word cards. Elements of patient education included information about daily self-care, medication, complications, and preventative care.
Conclusion: The authors suggest some strategies for the care of intracranial hemorrhage patients. These strategies include referral to rehabilitation organizations, information and education about aphasia and related diseases, and the development of communication between patients and major caregivers before discharging from the hospital.

並列關鍵字

intracranial hemorrhage ； aphasia ； paralysis