一位初次診斷肺結核患者之護理經驗

Nursing Experience of Caring for a Patient Receiving the First Diagnosis of Tuberculosis

本文旨在描述一位初次診斷肺結核患者服藥後不久發生肝炎之護理經驗。護理期間自2016年9月15日至2016年9月26日。在照護期間以Gordon十一項功能性健康型態為評估工具，發現個案因為初次診斷，對肺結核的傳染途徑、藥物治療及副作用、居家注意事項不了解，也擔心疾病預後、藥物副作用影響身體健康以及傳染給他人，而出現「焦慮」之護理問題；個案因為疾病本身及藥物副作用出現食慾減退、噁心感，而出現「營養少於身體所需」之護理問題。於護理過程中，筆者藉由傾聽及治療性觸摸，讓個案感受護理人員的關懷，再鼓勵個案說出擔心、害怕的事情及表達內心感受，與個案互動過程中也澄清其不正確的訊息及疑惑之處，並且提供完整的肺結核相關知識，以增加個案對疾病的認知，進而減輕其焦慮，此外，也與個案討論體重增加對疾病的影響，並教導如何採漸進式飲食增加熱量的攝取，以達到每天營養所需的熱量，個案體重增加也達到預期中，1星期增加0.5公斤。盼藉此護理經驗能提供護理人員作為日後照顧類似病人之參考。 This paper describes the nursing experience of caring for a patient who received the first diagnosis of tuberculosis and developed a complication of hepatitis after taking medicine. The nursing period was between September 15, 2016 and September 26, 2016. During this period, the author used Gordon's 11 functional health patterns to assess the patient's health. The author found that because this was the patient's first tuberculosis diagnosis, the patient was unfamiliar with mode of transmission of tuberculosis, medication treatment and its side effects, and care practices at home. In addition, the patient was worried about disease prognosis, side effects and disease transmission and thus exhibited anxiety. Tuberculosis and the side effects of medication caused nausea and loss of appetite in the patient, leading to imbalanced nutrition (less than body requirements). During the nursing process, the author cared for the patient through listening and therapeutic touch, thus allowing the patient to experience the nurse' warm concern. Furthermore, the author encouraged the patient to express feelings and speak out what she was worried about or feared of. The author also explained unclear information, clarified doubts, and provided complete knowledge about tuberculosis during the interaction with the patient. This increased the patient's awareness of the disease and relieved the patient's anxiety. Moreover, the author discussed the influence of weight gain on tuberculosis and taught the patient how to adopt an incremental diet to increase caloric intake and reach the calorie level required for daily nutrition, with a goal of gaining 0.5 kg per week. This nursing experience can serve as a reference for future nursing care of patients receiving a new diagnosis of a disease complicated by hepatitis.