照顧一位二次中風併合併症再度入院個案之護理經驗

A Nursing Experience of Caring for a Patient with Recurred Stroke

根據2010年統計，腦血管疾病是國人十大死因的前三位，這對國人健康及生活品質影響甚遠，此個案為一位77歲再次發生腦中風住院之老者護理經驗，照護期間2011年8月6日至8月18日止，運用Gordon十一項健康功能型態評估為工具，藉由個案住院期間的照顧會談及6次電訪進行收集資料，經由會談、觀察、身體評估等做為整體性護理評估，經內容分析整體發現個案的護理問題組織灌流改變－腦、無效性保護能力－出血、吞嚥功能障礙、自我照顧缺失活動、排泄型態改變－排尿等護理問題。護理過程中，依照個案病情的個別性，藉由鼓勵個案和家屬參與醫師、營養師、復健師等跨領域合作參與疾病治療過程，以正向支持鼓勵增加個案信心，協助個案面對疾病的身體失能，進而接受身、心復健治療，促進個案身體功能的恢復及改善自我照顧能力，達到生活適應。希望藉此護理經驗，可以提供護理人員照顧類似病患時，除了減輕其生理不適外，亦能重視以同理心深入了解其心理層面，藉由這篇護理經驗與大家分享急性期的照顧及復健過程，使個案達到完全照護。

According to the statistics in 2012, cerebrovascular accident (CVA) disease is the third leading cause of deaths in Taiwan. Complications caused by CVA can significantly affect one's health and quality of life. This article describes a 77-year-old patient admitted to the hospital with recurred stroke. The patient suffered from complications secondary to stroke, such as existing disabled extremities, swallowing difficulty, and altered bowel movement. The nursing period was from August 6 to August 18, 2011. The author used NIHSS (National Institutes of Health Stroke Scale), swallow test, and Gordon's 11 functional heath patterns tool for patient assessment. An integrated nursing assessment was done and data were collected through personal interview, telephone calls, observation, and physical assessment. The identified problems were altered cerebral vascular perfusion, which was related to CVA, existing injury secondary to medication-anticoagulant, swallowing problems due to poor muscle control and coordination, and lack of self-care. With the multidisciplinary team members, such as a doctor, nutritionist, and physical therapist, the patient and family were encouraged to participate in designing individualized nursing care plans and treatment, and training extremity muscle strength and swallowing ability. The family also learned how to assist the patient in daily living activities to facilitate the recovery of self-care as early as possible and promote functional capacity to lessen the complications.