一位全身性紅斑狼瘡合併第四型狼瘡腎炎患者之護理經驗

Nursing Experience of Caring a Systemic Lupus Erythematosus Patient with Class IV Lupus Nephritis

本篇個案報告探討一位27歲單身女性罹患全身性紅斑狼瘡合併第四型狼瘡腎炎，個案所面臨身、心等衝擊與調適過程的護理經驗，護理期間自2011年6月1日至6月21日，藉由訪談、觀察、身體評估等方式，運用Gordon十一項健康功能型態進行評估，確立個案有急性疼痛、身體心像紊亂、無力感等健康問題。依據個案個別需求，提供藥物治療、注意力轉移、穴道按摩、冰敷等緩解關節疼痛；教導個案使用低敏感性防曬隔離乳塗抹臉部皮膚，採淡妝方式修飾外觀的改變，以重建正向的自我心像。藉由觀看紅斑狼瘡紀錄片，教導並提供個案與家屬疾病相關知識及照護技巧，以減輕對疾病之不確定，增加自我控制的能力。藉由宗教力量增加個案的勇氣，協助參與病友團體活動，增加人際關係，引導個案找到生命的獨特性與價值，學習與疾病共處，進而達到正向的人生。照護期間除了提供狼瘡腎炎個案適切的生理照護外，協助個案得到心理最佳舒適狀態顯得格外重要，期望藉由本篇個案報告分享照護此類個案之參考。

This case report investigated the physical and psychological impacts, as well as the nursing experience, of a 27-year-old single woman’s adaptation to systemic lupus erythematosus (SLE) with class IV lupus nephritis. The nursing period was from 1st of June to the 21st of June in 2011. Interviews, observations, and physical assessments were implemented, with Gordon’s 11 functional health patterns used as a means of evaluation to confirm health problems such as acute pain, body image disturbance, and hopelessness in the patient. Medication, distraction, massage, and ice pack were provided according to the needs of the patient to relieve joint pain. The patient was taught to rub hypoallergenic sunscreen on her face and apply light make-up to cover up changes to her appearance so as to reconstruct a positive self-image. The patient and family members were asked to watch a documentary on SLE to increase their knowledge of the disease as well as to learn nursing techniques in order to reduce uncertainty towards the disease and increase self-control ability. The power of religion assisted the patient to participate in patient support group activities, which increased interpersonal relationships and guided the patient to find the uniqueness and value of life. The patient also learned to co-exist with the disease and adopt a positive attitude in life. In addition to providing suitable physical nursing to this patient with lupus nephritis, what especially important is to help the patient to be in the most comfortable mental status. This nursing experience is provided in hopes of serving as a reference for similar cases in the future.