照顧一位食道腐蝕性灼傷的老年自殺患者之護理經驗

Nursing Care of a Suicidal Elder Patient with Esophageal Corrosive Injury

食道腐蝕性灼傷是吞服化學性腐蝕劑所導致的損傷，輕則可使病患食道發炎紅腫而無法由口進食，重則會導致食道狹窄、食道糜爛穿孔的危險。護理的重點除了提供身體舒適、維持生理功能及預防合併症的發生外，亦需注重心理社會層面的重建。本文為筆者照顧一位吞服潔廁劑自殺，造成食道腐蝕性灼傷合併急性呼吸衰竭的老年病患之護理經驗。期間運用Gorden十一項健康功能評估，確立個案的護理問題有：急性疼痛、低效性呼吸型態及無效性因應能力等問題。筆者提供適當的護理措施，減輕個案口咽疼痛和吞嚥困難的情形，改善呼吸型態而成功脫離呼吸器；在心理方面，為協助個案正視自殺的導因，筆者與個案建立良好的護病關係，尋求家人的心理支持，提供社會資源，建立社交生活，使個案身心重建並發展正向的人生觀。此外，建議臨床上對於自殺患者除生理上的照護外，更需著重於心理社會問題的深入探討，方能使病患的身心得到完整的照護。Esophageal corrosive injury which is caused by ingesting caustic agents will lead to esophageal erythema, edema, being unable to intake food, and resulting even more serious problems of esophageal stricture, rotten danger and perforation. The nursing goal is to make patients comfortable, maintain their physiological function, prevent them from other complications, and pay attention to the reconstruction of the social aspect of psychology. The case study of a suicidal elder patient with esophageal corrosive injury and complicated with acute respiratory failure becamse he swallowed household cleaning products. The nursing problems were established according to Gorden 11-item Functional Health Pattern, to include acute pain, ineffective breathing pattern and ineffective coping. The author offered the appropriate nursing interventions to reduce oropharyngeal pain as well as difficulty in swallowing, improve breathing patterns by weaning from the ventilator; establish rapport with the patient, help the patient face the reason leading to suicide, seek mental support from family, offer social resources, set up social life, rebuild the patient’s physical and mental conditions, and develop more positive attitude towards life. My clinical findings suggeste that besides the physiological nursing of the patient suffering from suicide, future interventions may be needed to put more emphasis on understanding mental and social status for these patients.