年輕腦梗塞個案再次中風後的照護經驗

Nursing care Experiences of a Young Patient with Recurrent Stroke

本文是描述一位年輕型腦梗塞個案，原本對康復充滿期待，希望在出院後能重返自己熱愛的工作崗位，但卻在僅僅一周後又再次中風入院，導致右側肢體偏癱、吞嚥困難及言詞表達障礙，日常生活需完全依賴家人，對未來出現不確定性與無力感。照護期間為113年2月6日到2月18日，運用Gordon十一項功能性健康型態模式進行整體性評估，確立有吞嚥障礙、身體活動功能障礙、言詞溝通障礙及無力感之健康問題。藉由護理獨特性與跨團隊協助，調整食物質地，解除放置鼻胃管危機，進行言語與溝通訓練，恢復溝通能力，擬定個別性復健計畫，最後在單手杖輔助下得以步行出院。而此次照護經驗中，深感困難為協助個案克服再次中風引發之低落情緒，初期筆者因經驗不足而未能充分表達同理心，但透過與社工師合作，幫助個案走過人生低谷期，學習自我照顧技巧。故建議臨床單位應定期召開跨領域團隊會議，整合各專家意見，制定更適切的照護方案，並加強護理人員在心理支持方面的訓練，提高對情緒低落個案的照護能力，以提供更適切之照護計畫。期許此護理經驗能提供日後相似個案照護之參考。

This report describes a case of a young patient who initially had an ischemic stroke, with high expectations for recovery and a strong desire to return to work after hospital discharge. However, the patient was hospitalized again after a recurrent stroke just one week later, resulting in right-side hemiplegia, dysphagia, and expressive language disorder. The patient is fully dependent on family members for daily activities and has uncertainty and feelings of helplessness about the future. The nursing care period spanned February 6 to 18, 2014, during which a comprehensive assessment was conducted using Gordon’s Eleven Functional Health Patterns to identify health problems, including dysphagia, impaired physical mobility, impaired verbal communication, and feelings of helplessness. Through specialized nursing care and multidisciplinary team collaboration, the patient’s food texture was modified, eliminating the need for a nasogastric tube, and speech and communication training restored the ability to communicate. A personalized rehabilitation plan enabled the patient to ambulate at discharge using a single walking stick. A major challenge in this nursing care experience was assisting the patient in overcoming a low mood following a recurrent stroke. Initially, limited experience hindered the full expression of empathy. However, collaboration with social workers assisted the patient to navigate this difficult period and develop self-care abilities. Therefore, it is recommended that clinical units hold regular multidisciplinary team meetings to integrate expert opinions, formulate tailored nursing care plans, and enhance nursing staff training in psychological support, thereby improving care for patients with emotional distress. This nursing care experience may serve as a reference for managing similar cases.