一位食用中草藥導致抗膽鹼物質中毒個案之急診護理經驗

An Experience in Emergency Nursing of Patients with Anticholinergic Poisoning Caused by Chinese Herbal Medicine

中草藥一向被認為較天然，毒性副作用少，民眾誤食或不當使用造成意外中毒事件時有所聞。本文係探討一位食用中草藥導致抗膽鹼物質中毒個案之急診護理經驗，急診照護期間為2014年12月6日17時14分至2014年12月7日00時15分，筆者以Gordon十一項健康功能型態為評估架構，利用直接照護、會談、觀察及身體評估等方式收集資料，確立個案主要有「急性混亂」、「體液容積缺失」、「焦慮」之健康問題。在急性混亂期採集中照護、去除導因及協助恢復認知功能；給予輸液補充促進毒物排出、維持體液電解質平衡並監測生命徵象；運用溝通技巧引導個案說出焦慮感受、教導放鬆技巧及提供中毒物質相關資訊，減輕其焦慮來源。經上述護理措施介入後，個案急性混亂情形恢復，焦慮感減輕，亦無因體液容積不足造成脫水情形發生，於2014年12月7日11時37分病情穩定由急診室辦理出院。建議政府相關部門應加強宣導，呼籲國人勿食用來路不明的植物及中草藥，以免發生中毒事件，並期望藉此急診臨床照護經驗分享，增進醫護人員對含抗膽鹼物質之中草藥的認識，提供相關醫護同仁日後臨床照護的參考。

Chinese herbs are considered to have few toxic side effects because they are natural. Accidental poisoning due to misuse or abuse of chinese herbs medicine has been occasionally reported. Here, we report our experience in emergency nursing of a patient intoxicated with anticholinergic substances after consuming a chinese herb medicine from 17:14 on December 6, 2014 to 00:15 on December 7, 2014. Using Gordon's 11 functional health patterns as the assessment framework, we collected data through direct nursing, interviews, observation, physical assessment, and other methods, and ascertained that the patient primarily suffered from delirium, potentially fluid volume deficit, and anxiety. We eliminated the cause of the patient's intoxication, helped the delirious patient recover cognitive functions, administered fluid to promote the excretion of poisonous substances, maintained electrolyte balance, and monitored vital signs. Furthermore, we helped the patient express anxiety using simple forms of communication, taught relaxation techniques, and provided relevant information on toxic substances for alleviating anxiety. Consequently, the patient recovered from delirium, suffered from less anxiety, and had no fluid volume deficit. The patient was subsequently discharged from the hospital at 11:37 on December 7, 2014. We suggest that the government should increase publicity efforts cautioning people against consuming plants and chinese herbs medicine of unknown origins to avoid poisoning. This paper aims to promote a better understanding of chinese herbs medicine containing anticholinergic substances and provides a reference for health care providers for managing similar cases in the future.