一位紅斑性狼瘡缺氧性腦病變病人的居家護理經驗

Experience ofProviding Home Health Care to a Hypoxic Encephalopathy patient with SLE

本文描述一位初次罹患紅斑性狼瘡因關節痛、發燒送醫求治，住院期間疑似藥物過敏突然喪失意識，經急救後無法恢復意識須長期臥床個案，由於照顧者經驗不足，呈現焦慮不安現象。照護期間自2004年7月12日至2005年1月13日止，應用Gordon十一項健康功能型態評估架構，居家訪視8次及電話訪談3次，以身體評估、觀察、會談等技巧收集個案資料，發現主要健康問題有：1.潛在危險性感染，與導尿管路留置有關。2.照顧者角色緊張，與擔心個案需長期照顧及無相關照顧經驗有關。3.身體活動功能障礙，與疾病侵犯骨骼導致神經肌肉障礙有關。4.潛在危險性皮膚完整性受損，與疾病本身造成皮膚傷害及長期臥床有關。經由居家護理人員親切的衛教指導與支持鼓勵下，有效預防長期臥床相關合併症的發生，家屬也在參加家庭照顧者培訓班及照顧者支持性團體的座談會後，明顯減輕照顧上焦慮不安的情緒，相對亦提昇個案居家照護品質。This report describes a case of a first-affected Systemic Lupus Erythematosus patient who came to the hospital because of arthralgia and fever. During hospitalization, she suddenly lost consciousness, possibly due to drug allergy. Her consciousness did not recover after the cardiopulmonary resuscitation and she became bedridden. Because of lack of experience, the caregiver seemed very nervous. From July 12, 2004 to January 13, 2005, home care nurse assessed the patient and her family with Gordon eleven function health patterns framework, including eight home visits and three telephone interviews, with the skill of observations, interview, listening and interaction. Four health related problems were identified: 1. risks of infection; 2. strain of the caregiver; 3. impaired physical mobility, and 4. risks of impaired skin integrity. Under home health nurse's professional health education and supports, the family attended caregiver supporting group and education programs, which effectively prevented bedridden complication, released caregiver's anxiety, and improve home health care quality.