一位重症肌無力個案面臨初次重症肌無力危象之護理經驗

The Nursing Experience of Caring a Patient Facing Myasthenic Crisis the First Time

本文描述一位重症肌無力個案面臨初次重症肌無力之護理經驗。照護期間自 2017 年 8 月 18 日至 2017 年 9 月 4 日止，藉由觀察、會談、身體評估等方式，運用 Gordon 11 項健康功能型態評估分析資料，歸納出主要護理問題有：低效性呼吸型態、吞嚥困難及無力感。透過呼吸肌訓練維持氧合及增加肺活量；教導正確的鼻胃管灌食技巧及協助吞嚥訓練，終使其移除鼻胃管順利由口進食；主動關懷、引導個案說出內心感受，協助調適負向情緒，並提供疾病知識、家人與團體支持，使其以正向的態度重建自我價值，有效提升個案之生活品質。盼藉此篇護理經驗分享，提供給日後照護初次面臨重症肌無力危象個案之護理人員做為參考。

This article described the care of a myasthenia gravis patient facing her first time myasthenic crisis. The duration of nursing care was from August 18th to September 4th, 2017. Based on the Gordon's 11 Functional Health Patterns, three health problems were identified: ineffective breathing pattern, dysphagia, and powerlessness. Here is our strategy. First, we instructed the patient in respiratory rehabilitation exercises to relieve physical discomfort and increase vital capacity. Second, teaching correct nasogastric feeding skills and swallowing training facilitated nasogastric tube removal. Third, we encouraged the patient to express thoughts and adjust the negative emotions, provided the disease information and group support, and helped the patient to rebuilding self-esteem and improved the quality of life. The author shares this particular nursing care experience in the first time facing myasthenic crisis patient as a reference for future clinical care.