- 期刊
照護一位甲狀腺毒性週期性麻痺個案之急診護理經驗
Nursing Experience of Emergency Care for a Patient With Thyrotoxic Periodic Paralysis
摘要
本文描述一位46歲男性因甲狀腺毒性週期性麻痺致雙下肢突然無力之急診護理經驗，個案因未規則服用甲狀腺亢進藥物，造成低血鉀而引發肌肉無力，因擔心下肢癱瘓而出現焦慮，引起筆者深入探討的動機。筆者照護期間為2019年7月31日23：30至8月1日17：00，以直接照護、傾聽會談、觀察等方式收集資料，以生理、心理、社會、靈性層面進行評估，確立健康問題有身體活動功能障礙、知識缺失及焦慮。經過鉀離子補充、持續監測血鉀濃度、心電圖變化及四肢肌力，個案血鉀濃度恢復正常，沒有心律不整，四肢肌力也恢復；針對個案現有之症狀，機會教育個案疾病的症狀、徵象、疾病未控制的影響，藉此加深甲狀腺亢進疾病的認知及規則服藥的重要性；照護過程中也透過解釋目前的處置過程及後續治療方式，減輕個案的焦慮與緊張。建議個案在上海時可於就近醫院持續追蹤，或者可透過本院衛教網路途徑提供疾病衛教資料，彌補急診照護時間上的不足，以及輔助說明疾病的症狀與嚴重性，期望分享此照護經驗，讓急診護理師對於此類疾病能有更深入的了解，提升照護品質。
並列摘要
We describe the experience of providing emergency care to a 46-year-old man who experienced sudden bilateral lower extremity weakness induced by thyrotoxic periodic paralysis. Specifically, hypokalemia resulting from the patient's noncompliance with his hyperthyroidism medication schedule was determined to be the cause of the sudden muscle weakness. The patient was concerned about the possibility of lower limb paralysis. The care period was 23:30 on July 31 to 17:00 on August 1, 2019. Data were collected through direct care, attentive listening, observation, and assessments of the patient's physiological, psychological, social, and spiritual dimensions. The problems identified were physical function impairment, a knowledge deficit, and anxiety. After potassium supplementation, continuous monitoring revealed that the patient's blood potassium concentration had returned to a normal range, that he had no arrhythmia, and that his limb muscle strength had recovered. The patient was educated on the signs and symptoms of his disease and the consequence of leaving the disease unchecked, thus improving his understanding of hyperthyroidism and the importance of complying with prescribed medication schedules. The intervention and subsequent treatment strategies were also explained to the patient to alleviate his anxiety. Moreover, the patient was advised to continue disease follow-up when he returned to Shanghai and to access additional disease information from the health education website established by the case hospital. The experience shared herein can guide nurses in emergency care units in providing adequate care to patients with hyperthyroidism.