照護一位重度乾癬個案之護理經驗

A Nursing Experience of a Severe Psoriasis Patient Receiving Biological Agent Treatment

本文在探討一位罹患重度乾癬個案合併B型肝炎帶原者使用ustekinumab藥物治療之照護經驗。個案為38歲女性乾癬患者，因症狀反覆發作，影響身心及人際關係；筆者於2013年6月1日至2014年3月28日病人就診期間，運用Gordon十一項健康功能型態評估，透過會談、身體評估與病歷記錄收集資料，歸納其健康問題為：知識缺失、皮膚完整性受損、身體心像紊亂。針對健康問題擬定計畫，加強對治療藥物的認知、維持皮膚完整性及降低不適症狀、促進自我正向感覺。個案乾癬面積及嚴重度指數改善86%、肝功能正常、無肝炎復發，症狀控制維持38週。期望藉此護理經驗分享，能提供護理人員臨床照護之參考。

This study investigated the nursing experience of a carrier with hepatitis B and severe psoriasis treated with Ustekinumab. The patient was a 38 y/o woman who had experienced repeated onset of psoriasis symptoms, which affected her physiology, psychology, and interpersonal relationship. During the patient’s visits to the outpatient clinic from June 1, 2013 to March 28, 2014, the author used Gordon’s 11 Functional Health Patterns to assess the patient’s conditions, and used interviews, physical assessments, and medical records to collect data. The patient’s nursing problems were analyzed as followed: lack of knowledge, impaired skin integrity, and body image disturbance. To address these problems, the author developed a care plan that focused on the enhancement of the patient’s understanding on treatment drug, maintenance of skin integrity, reduction of symptoms of discomforts, and facilitation of positive self-perception. The patient’s psoriasis area and severity index (PASI) score was improved by 86%, the symptom control was maintained for 38 weeks, and normal hepatic function was also maintained without hepatitis relapse. It is hoped that the sharing of this nursing experience can serve as a reference for nursing staff in clinical care.