照顧一位缺血性腦中風合併吞嚥障礙病人之護理經驗

A Nursing Experience for a Stroke Patient with Dysphagia

中風病人約有50%會有吞嚥障礙。本文描述一位74歲女性，因腦中風合併吞嚥障礙的護理經驗。護理期間97年10月18日到97年10月25日，筆者運用Gordon十一項功能性健康模式評估，以及運用3盎司(90ml)的白開水測試吞嚥功能，並且在旁觀察、與家屬會談等技巧收集資料，發現個案有吞嚥障礙與神經肌肉功能障礙有關、身體活動功能障礙與神經肌肉功能障礙有關以及單側身體忽略與缺血性腦中風有關等護理問題。透過代償性的治療、口腔運動，並與物理治療復健師共同討論及照顧住院期間的復健治療，促使個案住院期間無肺炎的發生，左側肌肉力量由1分提昇到2分，且有重視左側肢體的存在。希望藉由此護理經驗能提供護理人員早期的進行完整吞嚥篩檢、處置，降低肺部發炎的機會，進而提昇照顧品質。

About 50% of stroke patients may suffer from dysphagia. This article describes a nursing experience for a 74-years-old ischemic stroke female with dysphagia. The period of nursing care lasted from October 18 to October 25, 2007. Data were collected via the Gordon's 11 Functional Health Pattern assessment tool and an interview with family members. For a swallow test, the patient was observed while drinking three ounces (90 mL) of water. Identified nursing care problems included swallowing dysfunction, impaired physical mobility, and unilateral neglect secondary to ischemic stroke. Through treatment of compensation, oral motor activities, and discussions with the physical therapist for an inpatient rehabilitation program, no complications such as pneumonia developed. Muscle strength of the left sided extremities improved from a score of 1 to 2. The patient started noticing the existence of left-sided limbs. By sharing this experience, the author hopes that the nurses caring for stroke patients can initiate a complete swallow test via a non-invasive screening tool and manage the issue of dysphagia as early as possible to minimize the possibility of pneumonia, and thereby enhance the quality of patient care.