一位路易氏體失智症合併精神行為症狀病人之照護經驗

Experience of Providing Nursing Care for a Patient with Dementia with Lewy Bodies and Behavioral and Psychological Symptoms

羅國峰(Kuo-Fong Lo) ； 戴湘玲(Hsiang-Ling Tai) ； 鄭惠美(Huey-Meei Jeng) ； 陸瑞玲(Ray-Ling Luh)

《榮總護理》 32卷2期 (2015/06) Pp. 136-144

https://doi.org/10.6142/VGHN.32.2.136

摘要

本文係探討一位因罹患路易氏體失智症（Dementia with Lewy Bodies, DLB）之82歲男性，因出現波動性（fluctuating）認知功能障礙、類巴金森氏症症狀、反覆性跌倒、漫遊等精神行為症狀並出現攻擊行為等之護理過程。於2012年9月1日至10月22日住院期間，筆者依據「精神衛生護理五大層面評估」透過會談、觀察、直接護理等方式收集相關資料後確立病人主要健康問題有：高危險性暴力、高危險性跌倒、思想過程改變、睡眠型態紊亂、自我照顧能力不足及家屬因應能力失調等。藉由關懷、陪伴與病人建立良好的治療性人際關係，提供治療性環境，教導放鬆技巧與個人因應能力，經由作息時間之調整及良好睡眠型態之養成等強化定向感護理措施，有效降低病人暴力行為及漫遊行為的頻率，並加強防跌護理指導、減少幻覺及妄想之強度、完成部份日常生活活動，提供照顧者支持並促進家庭和諧。期以此護理經驗之分享，提供護理人員日後照顧此類病人之參考。

關鍵字

路易氏體失智症 ； 行為精神症狀 ； 照顧者

並列摘要

This article describes our experience providing nursing care for an 82-year-old man with fluctuating cognition, parkinsonism, repeated falling, wandering, and psychotic symptoms, who was admitted because of aggressive behavior. The nursing period was from September 1st, 2012 to October 22nd, 2012. Our psychiatric nursing assessment encompassed an interview, observation, direct nursing care, and empathetic listening. Six major health problems were identified: high violence risk, high fall risk, altered thought process, disturbed sleep pattern, deteriorated self-care, and ineffective family coping. Our nursing plans included establishing rapport through empathy, company, and caring; providing mental support in a therapeutic environment and teaching relaxation and personal coping skills to enhance orientation; reconstruction of sleep patterns to reduce the frequency of violence and wandering; nursing education regarding fall prevention; reducing the intensity of hallucinations and delusions; increasing daily life activities; and providing support to enhance the harmony of the family. This article provides a reference for mental health nurses and other professionals regarding patient care.

並列關鍵字

dementia with lewy bodies ； behavioral and psychological symptoms ； caregiver

參考文獻

黃惠玲、劉錦螢、徐亞瑛(2006)．以家庭為基礎之社區失智症照顧模式簡介．長期照護雜誌，10(4)，333-341。

高潔純、林麗嬋(2005)．從安全概念探討失智者遊走行為的處置．長期照護雜誌，9(3)，223-232。

黃楚雲、黃錦章(2012)．巴金森失智症與路易氏體失智症．應用心理研究，55，59-98。

Aarsland, D., Kurz, M., Beyer, M., Bronnick, K., Piepenstock, N. S., & Ballard, C. (2008). Early discriminatory diagnosis of dementia with lewy bodies. Dementia and Geriatric Cognitive Disorders, 25(3), 195-205.

Ballard, C., Corbett, A., Chitramohan, R., & Aarsland, D. (2009). Management of agitation and aggression associated with Alzheimer's disease: Controversies and possible solutions. Current Opinion in Psychiatry, 22(6), 532-540.