照顧一位經歷莫拉克颱風之急性腦中風個案的護理經驗

Nursing Care Experience for a Victim of Typhoon Morakot who Suffered from Acute Stroke

本報告在探討一位罹患急性腦中風個案並經歷過莫拉克颱風及親近家屬死亡的護理經驗。護理期間自2009年12月1日至12月8日，筆者經由臨床的照護、會談、傾聽、觀察等技巧收集主客觀資料，並運用Gordon十一項健康功能型態評估個案的健康問題，確立個案有：腦組織灌流改變、身體活動功能障礙、創傷後反應等護理問題。在護理過程中運用個別性護理措施，密切監測並維持個案足夠的腦組織灌流，為避免顱內壓上升的情形發生；教導其主、被動全身關節運動及創傷後反應之照護，如：主動適時的陪伴和心理支持、行為及心理治療、認知及暴露治療、藥物治療…等並協助申請社會資源補助，提升出院後日常的自我照顧能力，藉由護理照護功能，降低疾病所遺留下的後遺症。本文藉分享此個案的護理經驗，期望能提供臨床護理人員對照顧此類個案之參考。

This study investigates the nursing care experience for an acute stroke patient who was a victim losing close relatives in the disaster of typhoon Morakot. Typhoon Morakot had caused landslides leading to complete destruction of housing and agricultural land. The victim suffered from sudden loss of residence and financial hardship. Although his family members had escaped from the storm and saved their own lives, the victim’s daughter-in-law passed away during her baby delivery, and the victim himself suffered from acute stroke. The victim experienced a series of physical and psychological sufferings. The period of nursing-care for this patient started from 2009 December 1st till December 8th. Through clinical care, counseling, listening and observational skills, the author has collected relevant subjective and objective information, and has applied the eleven Gordon functional health patterns in assessing of the health problems of this patient. The case was confirmed to have the following health problems: changes in brain perfusion, physical activity dysfunction, as well as, post-traumatic reactions. Throughout the nursing procedure, individualized nursing care measures were applied to maintain brain tissue perfusion, to teach active and passive joint motion exercises, in order to maintain muscular activity. Provision of active timely accompany, psychological support, nursing care for post-traumatic reactions, personalized care, and the recruitment of social resources with the assistance of the medical team, in order to solve the physical and psychological symptoms of the victim, to improve his post-discharge daily self-care ability, and to reduce complications of his illness. Through the experience, this case-report provides an example for future reference of nursing staff about clinical care of similar cases.