照顧一位多發性肌炎病人之護理經驗

Nursing Experience of Care for a Polymyositis Patient

本文係探討一位罹患多發性肌炎婦女，面對疾病復發造成身體功能障礙及心理衝擊之護理經驗。筆者於104年4月1日至4月8日護理期間，運用Gordon十一項功能性健康型態評估為工具，藉由觀察、會談等技巧收集資料，確立主要健康問題有潛在危險性活動無耐力/與近端肢體無力有關、吞嚥障礙/咽、食道及上顎肌肉受侵犯有關、焦慮/與擔心復發、合併症及影響家人有關。護理過程中，筆者藉傾聽、主動關懷與個案建立良好護病關係，鼓勵個案說出心中感受，提供個案疾病治療相關知識，使個案及家屬能瞭解持續疾病治療及復健運動的重要性，教導等長收縮運動，促進自我照顧能力，指導家屬協助關節被動運動、漸進性練習下床如廁等日常活動。經由上述護理措施，個案表示對復發已不會感到焦慮，且會努力執行肌肉及關節運動，希望儘快回復正常生活。選擇此個案理由是因51歲罹患多發性肌炎婦女，不明瞭疾病為何復發，且因肌肉發炎無力導致活動無耐力、吞嚥障礙，影響個案活動功能及家庭照顧者角色。因此建議臨床照護多發性肌炎復發、因肌肉無力逐漸加重造成生活不便之個案時，提供預防復發、復健指導及心理支持，減輕焦慮與活動無耐力。期望藉此護理經驗分享，提供護理人員日後照顧此類病人之參考。

This article explored nursing experience with a 51-year-old female suffering from polymyositis, physical dysfunction and psychological impact when the disease recurred. During the nursing period from 1st to 8th of August in 2015, through physical examination, observation and Gordon's functional health assessment tool, the patient's problems included potentially activity intolerance, impaired swallowing and anxiety. The author encouraged the patient to express and gave support and help for the patient and her families to understand treatment and rehabilitation exercises. They accompanied the patient to practice isometric exercise, joints passive exercise, and gradual exercise out of bed to the toilet. They also discussed the adjustment of daily life, related knowledge and self-care skills. Before discharge, the patient understood that the purposes of long-term use of steroids and immunosuppressive medication were to prevent recurrence. The patient indicated the effects, side effects and important notes of the medication, and understood the importance of continuous muscle contraction exercise, joint movement and the signs of recurrence. This experience provides a reference for nurses who are in charge of the care for similar patients in the future.