照顧一位初次腦中風個案之護理經驗

A Nursing Care Experience of a First Time Stroke Patient

本文敘述一位初次腦中風導致吞嚥困難、肢體無力、構音困難之護理經驗。照護期間為2015年12月3日至16日，透過傾聽、觀察及身體評估等方式，運用Gordon十一項功能性健康型態評估收集與分析資料。確立健康問題為吞嚥障礙、身體活動功能障礙、言辭溝通障礙、知識缺失及身體心像紊亂，運用跨領域團隊合作，與個案及家屬共同擬定照顧計畫，指導個案口腔運動、吞嚥及進食技巧、平衡訓練、肢體活動訓練及構音技巧等，並探究不按時服降血壓藥原因及面對疾病所致的心理衝擊主動了解病人內心感受及需求，鼓勵參與自我照顧計畫，提供相關訊息，改變中風前高血壓認知，及協同家人的支持，激發病人維持復健的動力，重新面對中風的影響，建立正向自我概念及疾病照護認知。期望藉此護理照護經驗日後能提供臨床照護之參考。 This article described a nursing care of a first time stroke patient suffering from dysphagia,weak limbs, and dysarthria. From December 3 to 16, 2015, the author adopted Gordon's 11 functionalhealth pattern assessment to collect and analyze the data of the patient with the strategies of interview,observation, and physical assessment. The confirmed major physical difficulties were impairedswallowing, physical mobility and verbal communication, as well as deficient knowledge, and disturbedbody image. By conducting multi-disciplinary cooperation, the author established a caring plan with thepatient and the family. First, the author instructed the patient in oral motor exercise, skills of swallowingand eating, balance and limb activity training, as well as articulation skill. Second, the author looked intothe reason of the patient not taking medications on time and the psychological impact when he faces theillness, so that the author could understand how the patient felt and what were needed, and encouraged thepatient participate in self-care plan. Furthermore, the author provided the patient with relevant informationto change his understanding of hypertension. With the support and cooperation from the family, the authorhad promoted the patient’s motive for rehabilitation, and the patient began to re-confront the impact ofstroke. The experience can be a reference for similar nursing cares in the future.