照顧一位運動經元疾病病患之護理經驗

Nursing Experience of Caring for a Patient With Motor Neuron Disease

運動神經元疾病（motor neuron disease）是一種神經系統運動神經元細胞逐漸退化死亡的疾病，患者又俗稱「漸凍人」。目前仍無有效藥物能治療，儺能以riluzole來肌肉力量的喪失，及以症動支持療法提高存活率。但病人終將因嚴重的全身無力續發肺部感染，導致呼吸困難而死（羅，民89；neartherlin， 1998）。本篇報告是一位運動神經元疾患，因症狀日益加重，須仰賴他人協助日常生活，擔心造成家人負擔，而服老鼠藥自殺。筆者於照顧個案期間，運用羅氏適應護理模式，在生理功能、自我概念、角色功能及相互依賴四個層面評估病人的健康問題，發現個案面對的問題有：營養狀況改變、身體活體功能障礙、自我照顧能力缺失及個人因應能力失調。筆者與個案及家屬建立良治療性人際關係後，以主動關懷，提供個案生理及心理的支持，增進其面對疾病的信心及生存的意義而能適應疾病。Motor neuron disease is a nervous system problem in which the motor neurons progressively degenerate and ultimately die. There is no known cure for motor neuron disease. Riluzole is being used to slow down the loss of muscle power. Supportive and symptomatic treatment is provided to improve the survival rat. However, the severe generalized muscle weakness and ineffective cough commonly leads to pulmonary infection, which is a frequent cause of death. This article describes the care of a motor neuron disease patient who took drugs to attempt suicide due to the severity of the disease, depending on others for daily life, and desire to avoid being burden for the family. Four modes of Roy Adaptation Model, which includes physiological function, self-cncept, role function, and interdependence were used to assess the patient's health problem. Nutritional alteration(deficiency), impaired physical mobility, self-care deficit, and ineffective coping were identified. The nurse first established good therapeutic relationships with the patient and the family, then showed her active caring, maintained the physical and mental support of the patient, and encouraged the patient to express his feelings. Hopefully, all of these interventions will increase the strength of the patient of face the disease and will assist the patient to find the meaning of living and finally better adaptation.