運用自我管理照護一位氣喘兒童之護理經驗

Utilizing Self-Management in the Care of an Asthmatic Child: A Nursing Experience

本文係描述一位十歲氣喘學童，因氣喘反覆急性發作，呼吸困難、喘鳴、夜咳、睡不好，多次至門急診求診，打亂個案生活秩序，影響學習，故藉氣喘個案管理機會，透過主動關懷，與個案及家屬建立良好治療性人際關係後，利用個案多次門診期間（2009年10月26日至2010年04月08日），以Gordon十一項功能性健康型態為評估工具，經由直接照護、會談、傾聽、觀察、身體評估等方式收集資料，確立個案有自我管理能力不足、照顧者角色緊張的護理問題。筆者運用自我管理照護方案，提供其個別性護理需求，引導個案及家屬習得更多正確的氣喘自我照護技巧，包括正確用藥、避免過敏原、用「峰速計」監測病情，以減輕個案發作的症狀，減少急性發作次數及疾病帶來的生活困擾。再以門診及電訪追蹤個案狀況，確定個案及家屬能調適生活，並持續執行護理照護技巧，病童因急性發作而就醫次數減少，能有效控制疾病，進而改善生活品質，提升自我形象。

This study described a 10 year-old school age child , because of frequent acute exacerbations of bronchial asthma, dyspnea, wheezing, night cough, poor quality of sleep, had to made frequent visits to the Emergency Department.This lead to a disruption of activities of daily living, affecting his learning opportunities. Using asthma self-management as chance to discuss this condition with the family, the author voluntarily approach the family and established good rapport and treatment relationship. This study covers the period between October 26, 2009 to April 4, 2010 [during the patient’s frequent OPD visits]. Using Gordon’s 11 functional health assessment as an assessment tool. The author used direct care, discussion, listening to the patient’s and the family’s complaints, observation, physical status assessment etc. to gather data. We established there were many difficulties arising from the patient’s lack of knowledge, poor compliance of medications and stress to the primarycare giver experienced in the care of the patient etc. The author utilized the self management method, giving special nursing teachniques and instruction to the patient and the family as to the proper asthma care and prevention. These included the correct use of medications, avoidance of allergens, disease assessment to monitor disease progression. This lead to lessening of the frequency of asthma attack, decrease in the frequency of acute exacerbations and a decrease in the disruption of the activities of daily living. Follow up during OPD visits and by telephone survey were made to evaluate the patient’s and the family’s compliance to the correct nursing techniques. Acute exacerbations of bronchial asthma decreased, more effective control of the disease lead the overall improvement of the quality of life and self image.