運用自我照顧理論協助一位肌萎縮側索硬化症病患之護理經驗

An Experience Nursing a Patient with Amyotrophic Lateral Sclerosis Using the Theory of Self-Care

肌萎縮側索硬化症（amyotrophic lateral sclerosis，ALS）是一種漸進性、致死率高的運動神經元退化疾病，目前仍舊病因不明，無有效治療方法，目前臨床治療包括Riluzole加上症狀支持療法來治療，但Riluzole僅能減緩病患肌肉力量的喪失，延長存活3-5個月的時間（Aventis Pharmaceutical，2004），病患終將會因為吸入性肺炎或呼吸衰竭而死亡。本文運用歐倫自我照顧理論，針對一位肌萎縮側索硬化症病患進行全面性護理評估，發現個案面對的問題有：「自我照顧能力缺失（穿衣、進食、如廁、沐浴）」、「潛在危險性跌倒」、「言詞溝通障礙」以及「無力感」等四項，針對這些問題提供適合的護理活動，提昇個案自我照顧能力，預防意外事故，增進非語言溝通的能力，以及緩解個案的無力感，增強其對疾病病程的控制感。

Amyotrophic lateral sclerosis (ALS) is a progressive and lethal motor neurodegenerative disease. The cause of the disease is unknown, and there is no cure current clinical treatment methods include Riluzole and supportive therapy. However, Riluzole only decelerates the patient's muscle strength loss and prolongs survival by about 3-5 months (Aventis Pharmaceutical, 2004). The patient will die eventually because of aspiration pneumonia or respiratory failure. This paper documents the use of Orem's self-care theory and holistic nursing assessment in a patient with amyotrophic lateral sclerosis. There are four areas of nursing concern impaired self-care ability (dressing, feeding, toileting, and bathing), risk of falls, impaired verbal communication, and powerlessness. In terms of these problems suitable nursing activities are provided to develop the patient's ability to care for himself, prevent accidents, promote skills of non-verbal communication, and alleviate powerlessness in order to strengthen control.