照護一位肌無力個案之護理經驗

A Nursing Experience for a Patient with Myasthenia Gravis

文為探討一位肌無力導致呼吸衰竭合併呼吸器使用的個案，因多次行呼吸器脫離失敗而對未來預後感到不確定，且主要照顧者因對疾病不了解及初次照護個案而感到緊張之護理經驗。護理期間為2014年9月29日至10月25日，筆者藉由觀察、身體評估、查閱病歷及筆談等方式蒐集資料，運用Gordon十一項健康功能型態進行評估，歸納主要護理問題有:1.呼吸器戒斷反應功能失常，2.無望感，3.主要照顧者角色緊張。筆者運用護理獨特性功能及個別性的呼吸器脫離計畫，以擬定相關護理措施，與個案建立良好的醫療關係，主動提供相關醫療資訊，並透過傾聽、關懷的方式，提供個案身體舒適與心理支持，鼓勵其表達內心感受及對未來的期望，適時給予回饋，以重拾個案對於生命存在的價值感，並使個案能順利脫離呼吸器。然而家庭間的支持及互動，也是影響個案成功脫離呼吸器的重要因素，故筆者亦針對主要照顧者，透過問題討論與回覆示教方式，教導其學習照顧技巧，並鼓勵照護者表達其內心擔憂，當照護者照護技能增強時，給予口頭鼓勵，以減輕照護上的緊張及增強自信心，提升住院中之照護品質，進而使個案出院後亦能有連續性及完整性的護理。期望藉此經驗分享能提供臨床護理同仁，在照護此類患者之參考。 This article describes the nursing experience of a Myasthenia Gravis leading to respiratory failure combined with a ventilator. and uncertainty about future prognosis due to multiple ventilator detachment failures, moreover, major caregivers feel nervous about their lack of the knowledge of the disease and the first time to taking care of them. The period of nursing care began from September 29th to October 25th, 2014. The information was collected through observation, physical assessment, chart review and written communication, and complete evaluation by the Gordon 11 function health patterns, the main problems were noted:1.dysfunctional ventilator weaning responses 2.hopelessness,3.the caregiver's role tension. The author uses the unique function of nursing and the ventilator-weaning training to formulate relevant nursing measures, establish a good medical relationship with the case, provide relevant medical information, provide comfort and psychological support through listening and caring, encourage them to express their inner feelings and expectations for the future, and timely give feedback to regain the value of life and to make the case living without the ventilator. However, the supports and interactions between families are also an important factor influencing the successful escape of the case. Therefore, the author also discuss their teaching methods through problem discussions and feedback, and encourages caregivers to express their inner concerns for the main caregivers. When the caregivers reinforce their care skills, give oral encouragement to alleviate the tension in care and enhance their confidence, improve the quality of cares in hospital, and then have enable continuity and integrity of care after leaving the hospital. It is hope that this experience could provide the medical teams with insight into further clinical care.