一位年輕心內膜炎併腦梗塞病人及其主要照顧者之護理經驗

A Nursing Experience of a Young Patient who was under Infective Endocarditis that Caused the Complication of Brain Infarction with his Primary Caregiver

本文係探討一位心內膜炎併腦梗塞的年輕個案及主要照顧者，面臨個案病情一再惡化，造成主要照顧者身心負荷之護理經驗。護理期間為2014年1月15日至1月31日，筆者經由直接照護、身體評估、觀察，與家屬會談及跨團隊合作討論會議等方式收集資料，依個案及其主要照顧者的生理、心理、社會、靈性等層面進行整體護理評估，結果發現個案有呼吸道清除功能失效；案母有個人因應能力失調、預期性哀傷等健康問題。在護理過程中，筆者除了持續密切監測生命徵象、維持呼吸道通暢、加強胸腔物理治療等；此外，耐心傾聽、深入了解其案母心理之壓力，陪伴其面對哀傷歷程，並透過跨科部團隊合作，讓案母了解未來治療方向及發展因應措施，減緩個案疾病對其帶來的衝擊與壓力。建議日後臨床護理師照護個案時，也應同時教導主要照顧者因應技巧和紓解壓力方法，以協助其渡過疾病過程，讓護理措施能更貼近主要照顧者的想法及需求。

This article described a nursing experience of a young man who was under infective endocarditis that caused the complication of brain infarction. As the disease worsened day by day, this brought his primary caregiver a heavy burden both physically and mentally. The duration of nursing care was from January 15th to January 31st , 2014. The author collected nursing data through primary care, physical assessment, meeting with the patient's family, and the conference of interprofessional team. The author disclosed that the patient had difficulty in ineffective airway clearance. The caregiver was ineffective in coping with unexpected situation and had anticipatory grief. During the nursing procedure, the author kept track on the patient's situation by monitoring vital signs and state of consciousness, maintaining airway patency, and providing appropriate physical therapy. Beside, being a good listener to the primary caregiverr, the author set out to discuss between medical teams. It made the primary caregiver understand the medical treatment in the future. Due to this case, it is suggested that the nurses should not only take care of the patient, but also caregiver. It makes the nursing closer to the caregiver's thoughts and needs.