照顧一位服用巴拉刈中毒學齡兒童之加護護理經驗

Intensive Nursing Experience of Caring a School-aged Child with Paraquat Intoxication

近年少年自殺及自傷的事件頻傳，無論是否對生命造成威脅，都已經對個案的心理造成傷害。本文探討一位服用巴拉刈中毒學齡兒童之加護護理經驗，在加護病房期間提供急性期的緊急處置，並與個案建立信任關係，藉由參與性觀察、直接護理及會談溝通等方式來收集資料，以羅氏適應模式作為護理評估之架構，確立個案之健康問題如下：(1)危險性自我傷害，與被同學嘲笑引起情緒失控、理想和現實間存在衝突有關；(2)口腔黏膜改變，與巴拉刈毒性物質造成口腔粘膜乾燥與潰瘍有關；(3)潛在危險性感染，與多種侵入性導管放置使用有關；(4)睡眠型態紊亂，與環境、舒適情形改變及治療干擾有關；(5)娛樂活動缺失，與住院治療及與外界隔離有關。個案從最初不願談論服用巴拉刈的原因，經筆者提供持續性關懷照護與引導後，轉變成願意和護理人員談論心中的想法，對於其疑問予澄清價值觀，引導個案來用不同觀點來看待事情，並給予正向鼓勵以增強個案的長處，最終得以協助個案面對生理及心理適應問題，除繼續追蹤生理狀況外，仍持續接受心理輔導，以防悲劇再度發生。

Child’s suicide and self-injurious events occur sometimes recently. Whether it damages to life or not, it will cause psychological damage to the child. This article explored the intensive nursing experience of caring a school-aged child with paraquat intoxication. The author provided emergent treatment in acute stage and established trust relationship with the child. Applying the Roy’s adaptation model as assessment framework, we collected data by using participant observation, direct nursing care and individual interviews. The client’s major health problems were as follows: (1) Risk for self-harm, related to derision of classmates causing emotion out of control and conflict between ideal and reality; (2) Impaired oral mucous membrane, related to paraquat intoxicity causing dry oral mucous membrane and oral ulcer; (3) Potential risk for infection, related to placement of various intrusive catheters; (4) Disturbed sleep pattern, related to environment, uncomfortable situation and treatment disturbance; (5) Deficient activity for diversion, related to hospitalization and isolation. The client first was unwilling to reveal the reason for paraquat intoxication. She became willing to talk with nurses at last. The author provided consistent caring and guidance to clarify her values, guided her to view things differently, and offered positive encouragement to reinforce her strength. Finally, nurses could assist the client to face physiological and psychological adaptation. In addition to continuous follow-up for physiological conditions, the patient sustained psychological consultation to prevent future tragedies from happening.