減少住院老人譫妄產生之護理經驗

Nursing Experience with Reducing Delirium in a Hospitalized Elderly Patient

本文描述一位因泌尿道感染入院的80歲老年患者的照護經驗。筆者以老年專科護理師的角色照護此病患，照護期間從民國94年5月11日至23日，經由詳細的評估、病歷記載、與家屬和機構護理人員聯繫，瞭解個案的認知與活動功能退化與上次加護病房住院產生的譫妄有關。為避免此次住院再度出現譫妄情形，設定三大護理目標，即控制感染、避免譫妄的發生、以及恢復原有的活動與自我照顧能力。採取的護理措施包括泌尿道感染的控制、管路的儘早拔除、環境因素的控制、以及肌肉力量和漸進式活動訓練等。經過近兩星期的照護，個案能自己由口進食，鼻胃管順利拔除，活動與自我照顧能力由完全依賴進步到部份協助，泌尿道感染雖獲得控制，但是尿管卻因攝護腺問題無法拔除，住院當中沒有再發生譫妄的現象，認知功能進步。由本文可知老年高危險性患者應即早做譫妄的篩檢與評估，並採取介入措施，以避免譫妄發生，進而影響認知與活動功能。期望此篇個案報告能提供為護理人員照護老年患者之參考。

This article describes an experience of providing nursing care to an eighty year-old patient with urinary tract infection (UTI). The author cared for this patient in the role of clinical geriatric nurse specialist from May 11 to 23 in 2005. Through comprehensive assessment, careful review of medical records, contact with family and nursing home healthcare workers, it was determined that the patient's cognition and physical function declines were due to delirium resulting from the last time the patient had been hospitalized in the intensive care unit (ICU). In order to prevent incidents of delirium, three nursing goals were set: controlling infection, avoidance of delirium recurrence, and recovery of prior levels of physical function and self-care ability. Nursing interventions used included UTI control, tube and catheter removal as early as possible, control of environmental factors, and muscle strength and exercise training. After two weeks of care, the patient could take food orally and the nasogastric (NG) tube had been successfully removed. Physical function and self-care ability improved from ”dependent” to ”partial assistance”. Although UTI was controlled, removal of the foley tube failed due to prostate hypertrophy. No delirious event occurred during hospitalization and cognitive functions improved. From this experience, early assessment and intervention should be conducted for high-risk elderly patients in order to prevent delirious events and declines in cognitive and physical functions. The author hopes this case report will prove a useful reference to nurses charged with caring for elderly patients at risk for delirium.