照顧一位服用巴拉刈中毒個案之急診護理經驗

An Emergency Nursing Experience of a Patient with Paraquat Self-Poisoning

本篇個案報告敘述一位服用巴拉刈中毒個案之急診護理經驗，照護期間自2014年7月30日至8月1日，藉由參與性觀察、直接護理、會談及病歷收集，以Gordon11項健康功能型態評估，確立三項健康問題：（1）急性疼痛：與服用巴拉刈導致口腔黏膜灼傷有關；（2）焦慮：與環境噪音、健康狀態受到威脅及擔憂病情進展有關；以及（3）自我殘害：與無法承受債務壓力而與案妻發生爭執有關。急診照護提供止痛劑、執行口腔護理，並使用轉移注意力技巧來緩解口腔黏膜疼痛；藉由陪伴傾聽及同理性回應，鼓勵表達其內心感受，重新建立正向思考模式，教導放鬆技巧以緩解焦慮。同時轉介精神科醫師及社工師協助，最終個案得以恢復正向價值觀及復原。

The study described an emergency nursing experience of a patient with paraquat self-poisoning. The nursing period lasted from July 30, to August 1 2014, during which the author collected data through participant observation, direct care, interview and medical chart review. Gordon’s 11 functional health patterns assessment was used as theoretical framework, and three health problems were identified: (1) Acute pain: related to oral mucosal damage from paraquat poisoning; (2) anxiety: related to environmental noise, threat to change of health status and distressed over disease progression; (3) self-mutilation: related to unbearable debt burden and dispute with his wife. We provided analgesics, oral care and attention diversion skills to ease the pain of oral mucosal injury. By companionship, listening and empathic response, we encouraged the patient to express his feelings to re-establish positive thinking and coping ability, and we taught the patient relaxation techniques to alleviate anxiety. We referred the patient to a psychiatrist and social workers for consultation. Finally, the patient was able to restore positive value and recovered.