一位體外震波碎石手術後併發腦梗塞病人及主要照顧者之護理經驗

Nursing Experience of a Patient with Cerebral Infarction after ESWL and the Caregiver

本文係探討一位體外震波碎石手術後併發腦梗塞病人及主要照顧者，面臨個案因腎結石執行體外震波碎石手術後併發腦梗塞，在非預期情況下入住加護病房，最後病情惡化終至死亡，造成家屬身心負荷之護理經驗。照護期間自2018年3月23日至2018年3月30日，經由臨床照護、傾聽與觀察、進行家屬座談及跨團隊討論會議等方式收集資料，運用Gordon十一項健康功能評估，確立個案護理問題有：呼吸道清除功能失效/與無咳嗽反射有關、腦組織灌流失效/與腦血管梗塞及血流動力學不穩有關；主要照顧者有：焦慮／與擔心個案病情變化致無法存活有關、預期性哀傷/與面對摯愛即將死亡有關等健康問題。護理過程中除持續監測個案生命徵象、維持呼吸道功能及利用升壓劑維持血流動力及腦組織灌流；藉由每日會客期間提供陪伴、耐心傾聽深入了解家屬的疑問，透過跨團隊會議召開家屬座談會進行溝通，引導案子了解未來醫療處置方向，適時的緩解心裡壓力與衝擊接受病情的變化。在個案臨終前，由護理人員引領案子幫個案更衣，抒發情緒及表達感受。在此次照護期間深刻體會到，醫療人員除照護病人外亦能多關注家屬之需求，理解家屬的情緒變化，主動提供訊息與支持，將有助於照顧者朝向正向適應，進一步建立治療性關係也是醫療團隊努力的重點，藉此分享經驗提供參考。

This article is about a patient with cerebral infarction after extracorporeal shock wave lithotripsy and the main caregiver. Faced with a case of cerebral infarction after performing extracorporeal shock wave lithotripsy for kidney stones, he was admitted to the intensive care unit under unexpected circumstances. In the end, his condition deteriorated and eventually died, which caused the family's physical and mental burden on nursing experience. The nursing period is from March 23, 2018, to March 30, 2018. Data was collected through clinical care, listening and observation, family discussions, and multidisciplinary teams meetings. By using Gordon's eleven health function assessments, the nursing diagnosis of the patient include, “respiratory function failure/related to non-cough reflex” and “brain tissue perfusion failure/related to cerebral vascular infarction and hemodynamic instability” . The nursing diagnosis of the main caregiver include, “anxiety/related to worrying about the patient's condition” and “grief/related to facing the death of a loved one” and other health problems. During the nursing process, in addition to continuous monitoring of vital signs, maintenance of respiratory function, and use vasopressors to maintain blood flow and brain tissue perfusion. In addition, during the visiting hours, by accompanying, listening patiently, and holding family seminars through multidisciplinary teams meetings, we can understand the impact and pressure of the patient is facing and let the patient understand the medical treatment direction. Finally, we assist the patient changing the clothes, and help the patient to express of emotions and feelings before died. During the nursing care period, the author realized that in addition to care for the patients, medical staff can also pay attention to the needs of family members and provide information and support proactively, which will help caregivers to adapt to the positive direction. The establishment of therapeutic relationships is also the focus of the medical team.