照顧一位年輕型腦中風合併吞嚥困難之護理經驗

Nursing experience of caring for a young stroke patient with difficulties swallowing

本報告為照顧一位年輕型腦中風合併呑嚥困難的年輕女性之護理經驗，照顧期間發現個案單側肢體無力，需依賴家屬協助日常生活照護，又有吞嚥困難護理問題，對自我喪失自信心而產生負向情緒，故引發筆者探討的動機。護理期間為2015年07月17日至2015年08月11日，筆者利用Gordon十一項健康功能評估架構，藉由會談、觀察、傾聽及身體評估等方式資料收集，發現個案有吞嚥功能障礙、身體活動功能障礙、身體心像紊亂等健康問題。藉由協助個案漸進式的肢體活動及吞嚥功能技巧訓練、鼓勵個案表達自我感受，協同中風個案管理師、營養師、復健師等跨領域團隊合作，使個案獲得情感支持且隨疾病的復原，個案對自我看法亦趨正面。因此建議醫療團隊人員須敏銳發現個案整體性的身心狀況，與個案建立良好醫病關係，陪伴患者完成復健計畫，回歸社會與重回職場。

This case report documents the nursing experience of caring for a 40 year-old female with difficulties swallowing after a stroke. Due to paralysis on her right side, her daily activities were limited and carried out with her husband's assistance. Her limited mobility and struggle swallowing added tremendously to her frustration with her situation. The nursing care period was from July 17, 2015, to August 11, 2015, and the author applied Gordon's 11 functional health patterns for nursing assessments. Through clinical observations and interviews, the following problems were identified: dysphagia, impaired mobility, and body image disorder. Rehabilitation, which consisted of gradual physical activity training and swallowing skill training, took place with the aid of a stroke nursing manager, nutritionist, and physical therapist. In conclusion, health care providers play a critical role in determining the patients' physical difficulties and psychological distress at an early stage in order to set appropriate goals and care plans earlier to assist the patients' rehabilitation program.