照顧一位重症肌無力患者之護理經驗

An Experience of Nursing a Client with Myasthenia Gravis

重症肌無力（myasthenia gravis）係自體免疫疾病，即自身產生抗體，破壞乙醯膽鹼接受器，導致神經肌肉聯合處的接受器對乙醯膽鹼之接收減少，以致神經衝動的傳導產生障礙（cross, 1999）。病患在疾病發生過程中因傳導障礙，常出塊低效性呼吸型態、高危險性肺吸入及活動無耐力等問題，不僅危害生命，更造成病患心理及社會各方面的衝擊。本文描述筆者在照顧一位重症肌無力患者之主護護理期間，藉由Gordon十一項健康功能型態進行護理評估，分析歸納個案六項主要護理問題，包括高危險性肺吸入、活動無耐力、知識缺乏、無力感、低效性呼吸型態及高危險性損傷，藉由多項護理措施的介入，終使得個案的不適症狀能獲得緩解，並提升個案及家屬對疾病的認知及照顧能力，進而改善其生活品質。

Myasthenia gravis is an autoimmune disease. It causes the formation of certain antibodies that attack acetylcholine receptors. The consequent reduction in the number of acetylcholine receptors causes impairment in the transduction of neural pulses (Cross, 1999). Clients usually present with ineffective breathing patterns, high risk of aspiration, and activity intolerance. Myasthenia gravis poses a threat not only to the lives of clients, but also of psychological and social impairment. The author describes the nursing evaluation undertaken during the process of caring for a client with myasthenia gravis, and, using Gorden's functional health assessment guide, summarizes six nursing problems, including high risk of aspiration, activity intolerance, knowledge deficit, powerlessness, ineffective breathing pattern and high risk of injury. Nursing intervention using multiple measures improved this client's symptoms of adjustment and understanding of the disease, while also raising the caring ability and quality of life of both client and family.