照護一位重症肌無力個案之加護經驗

Experience of Care A Myasthenia Gravis Patient with Respiratory Failure

本文描述照護一位61歲男性因重症肌無力併發呼吸衰竭之加護經驗。筆者於2018年5月7日至5月28日護理期間，運用Gordon十一項健康功能型態做為評估架構，透過身體評估、觀察、傾聽及筆談方式進行會談，將收集的資料進行整體性評估，在照護過程中發現個案有呼吸道清除功能失效、活動無耐力、焦慮之健康問題。藉由個別性、獨特性之護理，包括：（1）胸腔物理治療並配合呼吸器相關肺炎組合照護模式來幫助肺部擴張及早期脫離呼吸器；（2）教導上肢舉手和下肢抬腳等床上復健運動以增加四肢肌力力量及恢復自信心；（3）透過建立信任感之護病關係，運用傾聽及同理心來陪伴個案；（4）藉由精油按摩及音樂療法來放鬆心情；（5）協助加入台灣肌無力症關懷協會，使個案有同儕感以減輕焦慮。個案因面臨病情惡化而入住加護病房造成其內心極大的衝擊，並引起不安等情緒，因此引發筆者深入探討動機，並於加護病房急性期間經由跨團隊照護，結合復健師擬訂復健治療計畫，期望藉由經驗分享，提供護理人員相關照護之參考，進而提升照護品質。

This study described the experience of a 61-year-old man who received intensive care because of myasthenia gravis with respiratory failure. The nursing period was from 2018/5/7 to 2018/5/28 ,and the nurse carried out observations, conversations, listening, physical assessments in order to collect data. On applying the eleven functional health patterns as described by Marjory Gordon, it was found that the nursing assessment clarified certain nursing issues including ineffective airway clearance, Activity intolerance and anxiety, Individualized care was provided to this man, including (1) using chest physiotherapy combined with Care Bundles for Ventilator- Associated Pneumonia to improve lung expansion and early Weaning from Mechanical Ventilation;(2) instruct patient the skills of exercise such us arm elevation and lower limb lift knee to increase muscle strength and their self-confidence; (3) to establish a trusted nurse-patient relationship and employing listening skills, accompanying and empathy to help the patient; (4)using aromatherapy oil massage and music therapy that helps patients to relax; (5) assisted her in joining the patient association to promote peer relationship. The patient was admitted to the intensive care unit soon after her condition worsened, This had a substantial impact on the patient´s psychological state and induced distress and anxiety. Using multi-disciplinary care model to care and plan rehabilitation training with physiotherapist, As a result, discussion and sharing of the motivation of nursing experiences with this case in order to provide more information to our profession on caring in such a situation.