一位血液透析病人合併腦中風身心護理經驗

A nursing Experience of Caring for a Hemodialysis Patient with Stroke

本報告討論一位69歲血液透析病人合併腦中風的女性個案，因同時面臨須接受血液透析治療，又遭逢中風後肢體障礙復健成效不顯著的雙重壓力，持續的身心功能限制，產生無力感及疲憊問題，故引發探討動機。護理期間為2015年10月26日至2015年11月21日，運用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，發現個案有身體活動功能障礙、無力感及疲憊等健康問題。經給予正向的心理支持，鼓勵個案及家屬主動參與復健照顧計畫，教導自我照顧的技巧，提升自我控制力，降低無力感受，衛教改善疲憊感的策略，於家屬支持陪伴下，個案順利緩和疾病所帶來的身心壓力後出院。護理人員需敏銳發現個案整體性的身心狀況，主動關懷病人問題及需求，鼓勵表達內心感受，讓其參與自我照顧來增加自信心，將有助於復健及疾病恢復的成效。針對年老者的疾病衛教方式，除書面外，同時輔以多媒體方式增強衛教成效，有助增加民眾對腦中風治療及預防知識及瞭解。

This case report documents the nursing experience of a 69 year old regular hemodialysispatient who was admitted to the hospital due to a recent stroke. The case was stressful becauseof the ineffective rehabilitation. The nursing care period was from October 26, 2015 toNovember 21. The author applied Gordon's 11 Functional Health Patterns for nursingassessments, clinical interviews, and observations to identify the patient's nursing problems ofimpaired physical mobility, powerlessness, and fatigue. Therefore, the care plans includedproviding emotion support, encouraging self-rehabilitation, and teaching self-care and selfcontroltechniques to reduce the feeling of being powerless. With family support andaccompaniment, the patient was discharged after their physical-psycho stress decreased. Thenurse is a key health provider in identifying patients' physical and psycho health status. Thisarticle can be used as a reference for nurses caring for stroke patients.