照顧一位罹患淋巴血管平滑肌增生併發乳糜胸婦女之護理經驗

Nursing Experience with an Lymphangioleiomyomatosis Patient with Chylothorax

本文探討一位淋巴血管平滑肌增生婦女，因併發乳糜胸導致呼吸困難再度入院，及疾病所衍生不孕所引發心理衝擊之護理經驗。運用羅氏適應模式評估，發現個案的健康問題有：氣體交換障礙、急性疼痛、睡眠型態紊亂、情境性低自尊、焦慮等。筆者藉由會談、觀察、身體評估等方式收集資料，在護理過程中以同理心與個案建立良好治療性人際關係，透過主動關懷、傾聽、陪伴並鼓勵家庭重要成員的探視及彼此溝通，從中獲得支持、安慰進而讓個案接受自己，增加自我控制感，使個案在住院過程中漸獲身、心、社會各方面的適應。臨床護理不僅於提供生理照護需求，更應重視疾病以外心理層面諸多問題，使達完整的照護品質；藉此提出成功個案之護理經驗，期盼於專業領域中作經驗分享。

This article discusses experience providing nursing care to a patient suffering from Lymphangioleiomyomatosis who was re-hospitalized for recurrence of chylothorax complications, which caused dyspnea, sterility and mental instability. Based on parameters provided by Roy's adaptation model, the patient was identified as suffering from respiratory impairment, acute pain, sleep pattern disturbance and low self-esteem. Data was collected through interviews, observation and physical assessments. During the course of providing nursing care, the author established a good relationship with the patient through devoted attention to the patient's needs and by actively caring, listening and accompanying. Increased family member visits and interaction, resulting from the author's urgings, gave the patient added support and consolation. Eventually, the author gained the trust of the patient, who, in turn, regained self-control as well as physical and sociopsychological adaptabilities. Clinical nursing must attend to the physical care needs of patients as well as patient mental wellness, the latter of which extends beyond the disease itself, in order to achieve a truly comprehensive quality of nursing care. We are glad to share this successful experience with others in the nursing profession.