一位腦中風合併吞嚥障礙病人之照護經驗

The Nursing Experience for Stroke Patient with Dysphagia

國人罹患腦中風比率升高，腦血管疾病為十大死因第四位，死亡率7.6%。本文敘述一位因左側肢體乏力、臉部不對稱就醫，被診斷腦中風之個案，住院期間個案因進食會嗆、吞嚥障礙放置鼻胃管，以及身體活動功能障礙致部分日常活動需家屬協助而對預後感到灰心，產生低落情緒故引發筆者探討動機。護理期間自2019 年2 月19 日至3 月20 日，運用Gordon 十一項功能性健康型態之評估為架構，運用直接照護、觀察、會談、身體評估等方式進行資料收集，發現個案有吞嚥障礙/ 與神經肌肉控制失調、身體活動功能障礙/ 與中風後肢體肌肉力量減弱，部分日常生活須他人協助、身體心像紊亂/ 與身體功能改變及外觀改變等三項護理健康問題。照護期間鼓勵個案參與治療計劃，教導案女吞嚥照護技巧及肢體活動，持續觀察肢體復健恢復狀況，透過同理心、主動關懷及傾聽，協助個案面對疾病演變，引導個案以正向的態度面對，使其恢復吞嚥功能，提升左側肌力及增加自信心，儘早回歸社會及恢復日常生活。期望藉由此次護理經驗分享，提供臨床護理工作照護此類病人之參考。

"The incidence of stroke has been increasing in Taiwan. Cerebrovascular diseases ranks fourth among the 10 leading causes of death in Taiwan, with a mortality of 7.6%. This report described the experience of caring a stroke patient who sought medical treatment after experiencing left-sided hemiplegia and facial asymmetry. Throughout the period of hospitalization, the patient had a nasogastric tube inserted as she had dysphagia and often choked on food. Since she had impaired physical mobility, she also required assistance to perform some activities of daily living. As a result, she was disheartened by her prognosis and experienced feelings of rejection, which motivated the author to further explore this patient. The care period was from February 19 to March 20, 2019. A research framework was established based on Gordon's 11 functional health patterns. Data collection was carried out through the implementation of direct patient care, observations, interviews, and physical assessments. The findings revealed three health problems that the patient was suffering from: dysphagia, which is associated with neuromuscular dysfunction; impaired physical mobility due to post-stroke muscular weakness, which prevented her from performing some activities of daily living without assistance; and body image disturbance accompanied by changes in her physical functions and appearance. Throughout the care period, the patient was encouraged to participate in therapy, during which she was given lessons on swallowing techniques and physical activities. The patient's physical rehabilitation and recovery process was constantly monitored. Through the application of empathy, active care, and listening techniques by the care providers, the patient became able to cope with her disease-related changes; face life with a positive attitude; recover her swallowing ability; increase the muscular strength of the left side of her body; boost her self-confidence; and re-enter society to resume her normal life in a timely manner. It is hoped that this report can serve as a reference for providing clinical care for such patients."