一位初次罹患缺血性腦中風男性病人之加護護理經驗

The Critical Care Experience of a Male Patient with First-Time Ischemic Stroke

本文敘述一位初次腦中風發生吞嚥困難、肢體偏癱及因為無法接受突然的身體改變而導致無力感之加護護理經驗。如何提升個案身體功能與對未來的盼望，並以合適的方式增進外籍配偶共同照護的能力，是筆者的選案理由。照顧期間為2020年3月3日至3月15日，經觀察、身體評估、會談及查閱病歷等方式收集資料，運用羅氏適應模式層面進行整體性護理評估，確立個案有身體活動功能障礙、吞嚥困難、無力感等問題。透過跨領域的團隊合作，共同擬定照護計畫，運用主被動運動、復健活動、正確擺位、穿戴副木方式維持肢體位置及增進肢體功能。運用吞嚥評估確認吞嚥功能與嗆咳現況，設計個別化的吞嚥訓練於無力感的照護中，在主動了解病人感受與需求後，激發肢體復健的動機，藉由復健成效的進步、家屬及友人關心支持，及實際示範方式增強外籍配偶的照護能力，使個案對未來生活採正向態度。期望此護理照護經驗，提供日後護理同仁臨床照護之參考。

This article presents the critical care experience of a man who experienced powerlessness from debilitating dysphagia and hemiplegia and found it difficult to accept the sudden physical changes in his body after suffering from the first episode of ischemic stroke. This case was chosen to illustrate ways of not only improving the patient's physical function but also instilling hope for the future and strengthening the caring ability of the spouse residing abroad. Between March 3 and March 15, 2020, data were collected through observation, physical assessment, interviews, and review of the medical records. Roy's Adaptation Model was used for a holistic nursing assessment to determine the physical dysfunction, dysphagia, and powerlessness of the patient. A total care plan was also developed through interdisciplinary collaboration. Active and passive exercises, rehabilitation activities, proper positioning, and resting splints were applied to maintain limb positioning and improve physical functions. Swallowing function (including any choking episodes) was assessed, and an individualized swallowing training program was designed by a speech therapist. To address the patient's sense of powerlessness, after understanding the patient's feelings and needs, his self-motivation towards physical rehabilitation was promoted, and the patient was able to develop a positive attitude toward the future via a combination of rehabilitation progress, social support from families and friends, and increasing the care level of his spouse through technique demonstrations. We hope that this nursing experience may provide references for nurses in their daily clinical care.