劇烈運動後產生橫紋肌溶解症併發急性腎衰竭病患之急診護理經驗

The Emergency Nursing Experience of a Patient with Rhabdomyolysis with Acute Renal Failure after Strenuous Exercises

本文是照護一位33歲男性患者，因劇烈運動後導致橫紋肌溶解，產生全身酸痛、肌肉僵硬、倦怠無力、深茶色尿液等現象，至急診接受治療之護理經驗。護理期間為2009年2月19日至20日，筆者運用觀察溝通及身體評估等技巧收集資料，並運用Gordon十一項健康功能為評估架構，確立個案的主要健康問題有：(1)急性疼痛；(2)體液容積不足；(3)知識缺失（特定的）；(4)焦慮等四項健康問題。護理過程中提供個別性的護理，經由分散注意力、教導聽音樂及依醫囑使用藥物治療後緩解疼痛，疼痛分數由十分降低至三分；經由完善的給水計畫維持體液電解質平衡；知識缺失（特定的）經由口頭及書面護理指導橫紋肌溶解症的概念，終能瞭解橫紋肌溶解症之造成原因及治療處置，並接受正確的運動觀念提升對疾病的認知；經由主動向個案解釋病情與預後，鼓勵個案說出心中想法及擔心，陪伴並主動解釋病情，加上同理心的應用，患者的焦慮程度有顯著改善，並坦然接受後續治療和返家後自我照顧。

This article described the nursing experience of a 33-year old male patient with rhabdomyolysis caused by strenuous exercise. The patient experienced muscle stiffness, fatigue, dark tea-colored urine, soreness, and pain throughout his body. He was admitted into the emergency room for further treatment and care. The caring period was from February 19 to February 20, 2009. The author utilized observation, communication, and physical assessment skills to collect information. By using the Gordon 11 health function assessment scale, the primary health concerns of this case included: (1) acute pain; (2) insufficient body fluid volume; (3) knowledge deficit (with specificity); and (4) anxiety. The caring process was individualized, with distraction, guided music listening, and medication treatment to alleviate the pain. As a result, the pain score reduced from ten to three. The body fluid electrolyte level was maintained at balance level through a complete fluid infusion plan. The knowledge deficit was mitigated through oral communication and health education materials of rhabdomyolysis, eventually leading the patient to understand and recognize its causes and its process of care, and accept proper exercising concepts. By taking the initiative to explain the condition and the prognosis to the patient, and by encouraging the patient to express his thoughts and concerns, coupling with empathy, the anxiety level of the patient was significantly reduced. In the end, the patient readily accepted the follow-up treatment and agreed to self-care upon his return home.