照護一位吸毒感染愛滋病產婦之護理經驗

The Nursing Experience of Caring a Maternal Patient for Drug-abuse Infected with HIV

本篇探討一位36歲因注射毒品感染愛滋病產婦，先生為家中獨子，公婆希望夫妻倆育有小孩，故隱瞞病情直到妊娠35週住院行剖腹產，期間更拒絕公婆的關心及探視，只有先生及媽媽知道病情，個案面臨不能讓公婆及其他親友知道病情與產後、新生兒照護的經驗。2013年1月24日至1月29日於產後病房照護期間，以羅氏適應模式為護理架構，進行會談、觀察及身體評估，分析歸納出個案有急性疼痛/剖腹生產傷口、焦慮/新生兒感染和照護及社交互動障礙/未揭露愛滋病病情等三項主要健康問題。醫療團隊透過與個案建立信任關係，並依其健康問題提供照護措施，包括運用術後止痛、下床使用束腹帶減輕個案手術後的疼痛不適感，以促進舒適、提供愛滋疾病對新生兒影響及照護資訊，以提供新生兒預防感染照護技巧，適當時機安排公婆及親友至醫院探視個案等措施。並經個案同意電訪得知，出院二個月後，個案已主動向公婆坦誠夫妻染病事實，並獲得公婆諒解及支持。因愛滋病毒可能於分娩和哺餵母乳過程傳染給新生兒，建議新生兒應定期追蹤檢查，以及早提供預防性治療及持續性的照護。期盼透過照護此個案之護理經驗，能提供臨床護理人員照護愛滋孕產婦個案之參考。

The case report described the nursing experience of caring a 36-year-old HIV-infected maternal with pregnancy at 35 weeks who accept caesarian operation at post-partum ward. The case was HIV infected via drug injection. Her husband is the only son and parents-in-law hope the couple to bear a child. The case hided her HIV-infected condition and refused her parents-in-laws to visit and care during the hospitalization. The case also asked the medical staff not to disclose her HIV-infected status to her parents-in-law and all other relatives, exception of her husband and her mother. The nursing period was from January 24, to January 29 in 2013 according to Roy Adaptation Model as a nursing framework. Interviews, observation, and physical examination were implemented to confirm three major health problems, which included acute pain/caesarean operation wound, anxiety/neonatal infection and neonatal care, and social interaction disorders / to occult AIDS. Through medical team and according to the cases of health problems to establish a trust relationship and nursing interventions, including the use of pain control to reduce the pain after surgery and discomfort in order to promote her comfort, to provide the information and home care of HIV-infected mother affecting on her baby, to provide neonatal care techniques for preventing infection, and to arrange the appropriate timing for her parents-in-law and other relatives to visit in the hospital. After the interventions, improve the case postpartum pain and discomfort. Also the case accepts her parents-in-law to visit. The case was discharged two months later via telephone interview through the case consent. The case has actively and frankly informed HIV-infected facts to her parents-in-law, and also obtained understandings and supports from them. In addition, her newborns also received regular and adequate treatment. The AIDS virus may infect to the newborn through the delivery and breastfeeding process. The report suggestions that the newborn should be regularly followed up, so that early treatment and continuous care can be provided. The results of nursing experience will provide proper clinical care as a reference for similar HIV-infected maternal cases in the future.