日本腦炎併發身體功能障礙合併症護理經驗

Abstract

本文描述個案因日本腦炎導致身體活動出現異常,併發痰液清除功能不佳需長期照護而住入慢性病房,以及長期住院產生心理反應等相關問題。護理期間 2018/9/27-11/19 以 Gordon 進行十一項功能性評估,藉由觀察、身體評估、查閱病歷等收集資料,健康護理問題有呼吸道清除功能失效;身體活動功能障礙;焦 慮。護理措施 : 維持半坐臥式;背部叩擊;深呼吸及有效咳嗽技巧,強化咳痰能力;漸進式復健計劃合併中醫療法,提升肢體功能及自我照顧能力,讓個案拾獲自信心 參與復健;主動關懷讓個案表達更換管路感受,陪伴降低不適。藉由音樂、嗅覺 /冥想等減輕焦慮程度,正向因應疾病,建議未來住院的病人,在中醫醫療有針灸治 療健保給付,提供日後照護此類個案之經驗參考。  This article describes the care experience of a case of Japanese encephalitis complicated with physical disability from September 27, 2018 to November 19, 2018. The patient was admitted to a chronic ward due to poor sputum clearance, required long-term care and had psychological problems due to a long hospital stay. Gordon’s Functional Health Patterns were applied for health assessment. Data collection was completed through observation, physical assessment, and medical records review. Health problems were identified as ineffective airway clearance/thick sputum, impaired physical mobility/Japanese encephalitis infec- tion with neuromuscular injury, and anxiety/worry about disease prognosis. Nursing interventions included: maintaining semi-Fowler’s position; chest percus- sion; deep breathing and effective coughing techniques to strengthen sputum production; a progressive rehabilitation plan combined with acupuncture treat- ment of Chinese medicine to improve part of the physical function and self-care ability, so that the case could find self-confidence and participate in rehabilita- tion; active care and letting the case to express feelings about changing tubes, and accompanying reduction of discomfort; and relieving anxiety by listening to Taiwanese songs, practicing meditation, and responding positively to the illness. It is recommended that future hospitalized patients using traditional Chinese acupuncture therapy should be covered by health insurance. We hope the sharing of this nursing experience can be beneficial to the care of similar patients.