一位罹患惡性胸腺瘤重症肌無力患者之護理經驗

A Nursing Experience of a Patient with Malignant Thymoma and Myasthenia Gravis

本文描述一位43歲惡性胸腺瘤合併重症肌無力女性患者的護理經驗。筆者於2012年10月13日至2012年10月31日護理期間，運用Gordon十一項健康功能評估為工具，透過直接護理、觀察、筆談、身體評估及病歷查閱等方式進行資料收集，確認其有低效性呼吸型態、營養少於身體所需與無望感等健康問題。透過主動關懷、陪伴、傾聽來建立互信關係，藉由呼吸復健運動改善通氣狀態維持氧合，緩解其生理不適，提供高熱量、高蛋白飲食來改善其營養，運用衛教手冊說明疾病的進展，邀請家屬參與治療連結支持網絡，結合跨領域團隊照護使其能坦然接受治療。希望藉此分享面對惡性胸腺瘤合併重症肌無力的女性患者，除需重視身心安頓外，更要透過家庭支持系統激發其生存的意念。

This article describes the nursing experience of a 43-year-old female patient with malignant thymoma and myasthenia gravis. Information was collected via direct nursing, observation, written communication, physical examination, and chart review from October 13, 2012 to October 31, 2012. Gordon 11 Function Health Patterns for complete evaluation was used. Problems identified included ineffective breathing patterns, malnutrition, and hopelessness. A relationship of trust was built through caring, companionship, and listening. Respiratory rehabilitation exercises were provided to improve ventilation, to maintain oxygenation status and to relieve physical discomfort. High-calorie and high-protein diets were provided to improve nutrition. Health education manuals were used to describe disease progression, while the family members were invited to participate in treatment-linked support networks combining with interdisciplinary resource management to help the patient readily accept needed treatments. This article shares the experiences of caring for the physical and psychological needs of female malignant thymoma patients with myasthenia gravis and demonstrates how family support system can encourage patients to receive treatments and fight against malignancy.