照護一位格林——巴瑞症候群個案之護理經驗

Nursing Experience in Caring for a Guillain-Barré Syndrome Case

本文敘述照護一位因罹患格林-巴瑞症候群導致肢體無力，併發呼吸衰竭行氣切手術合併呼吸器使用個案，產生情緒低落、無望感之護理經驗。護理期間自2014年3月12日至3月31日，筆者藉由觀察、身體評估與簡易注音符號圖卡進行會談等方法收集資料，運用Gorden十一項健康功能型態進行評估，歸納出個案主要護理問題為身體活動功能障礙、呼吸道清除功能失效及無望感。護理期間筆者並利用主動關懷，鼓勵個案表達內心感受，同理並接受個案負面情緒的宣洩，透過家人的支持與跨團隊合作，提供疾病與治療相關衛教訊息，與個案及家屬共同討論治療方向，鼓勵個案參與照護計畫增進自主權，以強化自我照顧的動機，減輕個案對疾病產生的焦慮與害怕，協助渡過無望感。引導認知復健的重要性，並依個案能力安排復健活動，利用肌肉力量訓練來協助呼吸器脫離，發展有效咳痰能力維持呼吸道通暢，改善因肢體功能障礙而關節攣縮之合併症，以提升個案最佳的生活品質。期望藉此經驗分享建議醫護人員在照護此類個案，除了生理需求滿足外，更需注意個案心理層面的支持，使其個案重捨信心並以正向態度積極面對未來復健之路。 This article describes the care experience of a person who resulting in suffers from limbs weakness due to with Guillain-Barré syndrome, and who tracheostomy combined with respirators using respiratory failure to produce a feeling of depression and hopelessness. During the nursing period, from March 12 to March 31, 2014, the author collected data by means of observation, physical assessment and a simple phonetic symbol card, and used Gorden's eleven health functions to evaluate and summarize the cases. The main nursing problems are physical activity dysfunction, respiratory clearing function failure and hopelessness. During the nursing period, the author accepts the catharsis of the negative emotions of the case and used active care to encourage the case to express inner feelings and provide support for the disease and treatment through the support of the family and cross-team, and discuss the treatment direction with the case and family members. We also encourage cases to participate in the care program to enhance autonomy, to strengthen the motivation of self-care, to alleviate the anxiety and fear of the disease caused by the case, and help to not feel hopeless. We let the case understand the importance of rehabilitation plan, and arrange rehabilitation activities according to the ability of the case, use muscle strength training to assist the ventilator to detach, develop an effective cough ability to maintain airway patency, improve the complication of joint contracture due to limb dysfunction, and improve The best quality of life in the case. It is hoped that this experience will share the recommendation that medical staff should take care of such cases. In addition to the physiological needs, it is also necessary to pay attention to the psychological support of the case, so that the case will regain confidence and positively face the road of future rehabilitation in a positive attitude.