台灣專科護理師學刊Pub Date : 2022-12-01DOI: 10.53106/2410325x2022120902006
陳盈螢 陳盈螢, 陳金凰 Ying-Ying Chen, 張簡志炫 Chin-Huang Chen
{"title":"一位53歲男性以右小腿紅疹與腫脹為表現","authors":"陳盈螢 陳盈螢, 陳金凰 Ying-Ying Chen, 張簡志炫 Chin-Huang Chen","doi":"10.53106/2410325x2022120902006","DOIUrl":"https://doi.org/10.53106/2410325x2022120902006","url":null,"abstract":"\u0000 胰臟炎、脂膜炎與多發性關節炎症候群（pancreatitis, panniculitis, and polyarthritis, PPP）是胰臟疾病患者罕見發生於肢體的合併症。雖然PPP症候群罕見，當延遲診斷或缺乏胰臟炎治療時會導致高死亡率。本個案為53歲男性胰臟炎史，此次因右小腿長期反復發紅性皮疹腫脹和復發性雙膝關節炎，經相關檢查後診斷為右小腿膿瘍與多發性膝關節炎住院，於施行右小腿手術中發現與組織病理報告皆有脂膜炎病徵之異常呈現；雖然個案無腹部不適主訴，但回溯先前腹部電腦斷層有滲出性胰臟炎發現，因此於治療後期診斷為PPP症候群，持續給予適當抗生素和抗胰臟炎藥物治療使症狀獲得改善。因此當臨床遇見中年男性胰臟病史患者、伴隨反復性下肢腫脹、發紅性皮疹和復發性膝關節炎症狀，則胰臟炎、脂膜炎與多發性關節炎症候群就必須列入考慮，以避免錯失治療先機。The pancreatitis, panniculitis, and polyarthritis (PPP) syndrome is a complication that rarely occur inthe limbs of patients with pancreatic diseases. Although PPP syndrome is rare, the mortality rate is high due to late diagnosis, or the lack of pancreatitis treatment. The case is about a 53-year-old man with a history of pancreatitis. This time the patient was hospitalized due to long-term recurrent skin rashes, swelling of the right calf, and bilateral knee arthritis. After necessary examinations, he was initially diagnosed with right lower leg abscess and knee polyarthritis. However, there were abnormal signs of panniculitis from operative findings and histopathological reports. Although the patient had no complaint of abdominal discomfort, but exudative pancreatitis was discovered through backtrack-ing the computer tomography. Therefore, he was diagnosed with PPP syndrome at the later stage of the treatment and continued to undergo appropriate antibiotics and anti-pancreatitis medications until the symptoms were improved. Consequently, when a middle-aged man with a history of pancreatic disease is encountered clinically, accompanied with repetitive lower limb swelling, skin rashes and recurrent knee arthritis, the PPP syndrome must be considered to quire early treatment opportunity.\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"2013 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114926066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"一位67歲男性以反覆發燒為表現","authors":"邱子瑄 邱子瑄, 黃妙慧 Tzu-Hsuan Chiu, 王立信 Miao-Hui Huang, 葉惠玲 Lih-Shinn Wang","doi":"10.53106/2410325x2022120902008","DOIUrl":"https://doi.org/10.53106/2410325x2022120902008","url":null,"abstract":"\u0000 發燒是相當普遍的症狀表現，但後續評估釐清原因，並盡早確認診斷治療更是臨床一大考驗。本案是一位67歲男性，因兩週前反覆發燒合併寒顫、腹痛、全身痠痛，外院診斷泌尿道感染口服抗生素治療無效，因兩天前併發呼吸喘及頭痛就醫，本院急診初步診斷敗血性休克合併多重器官衰竭入院治療。筆者為感染科專師，照護期間為2019 年11月12日至12月10日，經詳細病史詢問及身體評估，因個案有猴子咬傷接觸史，醫療團隊初步疑似恙蟲病合併鉤端螺旋體感染，立即開立恙蟲病及鉤端螺旋體檢驗並同步給予兩種抗生素治療，於2019 年11月27日確診恙蟲病，治療後感染及敗血性休克得以控制，呼吸、腸胃、肝腎功能逐漸恢復改善，個案順利健康出院。針對反覆發燒為表現之患者，必須仔細詢問職業史、旅遊史、接觸史及群聚史，當個案屬於恙蟲病高風險感染族群時，即使未發現焦痂，在流行區仍須將恙蟲病列為鑑別診斷，以免錯失治療時機。\u0000 Fever is a common clinical symptom and it is crucial to assess the etiology for appropriate treatment.This article describes the nursing experience of a 67-Year-Old male patient with recurrent fever, ac-companied by chills, abdominal pain, and general soreness. Septic shock and multiple organ failure further developed. A thorough history was performed by the author as a nurse practitioner. Physical assessments, and primary care were conducted between 12th November and 10th December 2019. Ac-cording to the history, the patient was bitten by a monkey prior to the episode. Scrub typhus and/or leptospirosis co-infection were highly suspected. Immediately after the blood tests for scrub typhus and leptospirosis, empirical antibiotic treatment was applied. Scrub typhus was confirmed on 27th November, 2019. Septic shock, respiratory failure, gastrointestinal tract symptoms, hepatitis and renal failure gradually resolved after the treatments. The patient fully recovered and was discharged without sequelae. Thorough history taking including travel, occupation, contact, and cluster (TOCC) is very important to identify febrile diseases. For timely treatment, including scrub typhus into differential diagnosis for the patients with high risk is suggested, despite no eschar was found.\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130810061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
台灣專科護理師學刊Pub Date : 2022-12-01DOI: 10.53106/2410325x2022120902009
許瑞芸 許瑞芸, 周怡伶 Jui-Yun Hsu
{"title":"以反覆性腹痛合併癲癇表現之急性間歇性紫質症","authors":"許瑞芸 許瑞芸, 周怡伶 Jui-Yun Hsu","doi":"10.53106/2410325x2022120902009","DOIUrl":"https://doi.org/10.53106/2410325x2022120902009","url":null,"abstract":"\u0000 急性間歇性紫質症是一種罕見的遺傳性代謝異常疾病。本案例是一位38歲女性病人，起初反覆性腹痛合併噁心、嘔吐、腹瀉之表現，後續發生癲癇大發作及急性呼吸衰竭，經實驗室檢驗及影像檢查，僅呈現低血鈉、白血球增加，其他無異常發現。由於發現尿液偏褐色，進一步檢驗發現尿液中高胺基酮戊酸、高膽色素原，以及血液中低膽色素原脫胺酶，確診急性間歇性紫質症，經血基質治療後臨床症狀逐漸改善並順利出院。針對此類以腹痛合併癲癇表現的病人，且與低血鈉之徵象並存時，必須將急性紫質症列為鑑別診斷之一，以免延誤治療時機。\u0000 Acute intermittent porphyria is a rare genetic metabolic disease. In this case, a 38-year-old female pa-tient who experienced recurrent abdominal pain with nausea, vomiting, and diarrhea, following with epileptic seizures and acute respiratory failure. After the laboratory and image examinations, hypona-tremia and leukocytosis were only noted without other abnormal findings. Because of brownish urine, further laboratory examinations were performed. High level of aminolevulinic acid and porphobilino-gen of urine, and low level of porphobilinogen deaminase of blood were revealed. Acute intermittent purpura was diagnosed eventually. After human hemin treatment, the clinical symptoms gradually im-proved, and the patient was then discharged. For such patient with abdominal pain, refractory epilepsy, and coexisting hyponatremia, acute intermittent purpura should be considered as differential diagnosis for punctual treatment.\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123606117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"行動應用程式於護理教育的研發與運用","authors":"何蕎若 何蕎若, 李明忠 Chiao-Jo Ho, 邱文璽 Ming-Zhong Li, 鄭夙芬 Wen-Hsi Chiu","doi":"10.53106/2410325x2022120902002","DOIUrl":"https://doi.org/10.53106/2410325x2022120902002","url":null,"abstract":"\u0000 Z世代（又稱I Generation）的學生成長於網路科技快速發展的環境，習慣依賴網路來搜尋資訊，學習偏向視聽刺激，較不喜歡閱讀或聆聽講述。近年來行動應用程式在教育的領域中使用頻率越來越多，學生可以透過行動應用程式隨時隨地取用各種學習資訊。行動應用程式（App）應用到護理教學中，不僅能符合學生的學習需求，更可提高學習成效。多數App設計都是要寫程式，護理教師只能提供課程專業知識 （know how），其App相關內容則需要仰賴科技人設計，設計成本貴，大多需要倚賴經費支援。本文將從行動應用程式談起，說明製作免編程App的操作技巧，探討其優點與限制，同時說明護理教育者如何在有限的資源下，製作一個創新有趣的行動應用程式App。期望未來護理教育者能發展出一個專屬自己的行動學習App，激發學生學習動機，提升學習成效。\u0000 Generation Z students (also known as I Generation) grew up in a rapidly developing environmentof Internet technology. They prefer to search information from the Internet rather than reading and listening to the lecture. Recently, mobile applications have been adopted frequently in education. Stu-dents can use different apps to get information and learn without limits. The application of Mobile applications (App) can not only meet the learning needs of students, but also improve the effectiveness of learning in nursing. Most Apps design requires programming. However, nursing educators can only provide professional knowledge (know how). App-related tasks need to be performed by technologists. The cost is expensive and financial support is required. The article starts with a brief introduction of mobile apps, and then explained the operating skills of making programming-free apps. Finally, the advantages and limitations of Apps are discussed, and how nurse educators could make an innovative and interesting mobile app with limited resources is explained. It is hoped that nurse educators can develop their own mobile learning Apps to increase students’ learning motivations and to improve learning effectiveness in the future.\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116857162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
台灣專科護理師學刊Pub Date : 2022-12-01DOI: 10.53106/2410325x2022120902005
陳宜伶 陳宜伶, 宋怡憓 Yi-Ling Chen, 周怡伶 Yi-Hui Sung
{"title":"一位主動脈竇動脈瘤破裂之罕見案例","authors":"陳宜伶 陳宜伶, 宋怡憓 Yi-Ling Chen, 周怡伶 Yi-Hui Sung","doi":"10.53106/2410325x2022120902005","DOIUrl":"https://doi.org/10.53106/2410325x2022120902005","url":null,"abstract":"\u0000 主動脈竇動脈瘤是一種罕見的心臟結構病變，因具非特異性表徵及困難診斷，容易導致高死亡風險。本案例是一位53歲男性患者，因急性胸痛入院治療，藉由實驗室檢查發現心肌酵素升高、D-二聚體升高，心電圖檢查為aVR導程ST段上升、於第I、II、V4~6導程出現ST-T波段變化，初步診斷為左冠狀動脈主幹心肌梗塞，立即行冠狀動脈攝影檢查發現無異常。個案出現胸痛合併心因性休克之症狀，從中排除主動脈剝離、肺栓塞、心包填塞等診斷，深入檢視病史紀錄及影像報告，發現心臟超音波、胸部電腦斷層及冠狀動脈血管攝影檢查有由左流向右心室的瘻管分流，最終確診為主動脈竇動脈瘤破裂。患者緊急接受右冠狀竇動脈瘤修補及主動脈瓣置換手術治療後，胸痛、休克狀況改善且左心室功能恢復，術後預後良好。在面對急性胸痛合併血液動力學不穩定的患者時，除了須考慮症狀相關的疾病診斷外，當聽診發現S1及S2連續性心雜音時，建議將主動脈竇動脈瘤破裂列入考慮，以掌握治療處置之重要時機。\u0000 Aneurysm of the sinus of Valsalva is a rare cardiac anomaly due to the nonspecific symptoms and dif-ficult confirmation of diagnosis leading to high mortality. This report describes the case of a 53-year-old man who had suffered from acute chest pain. The electrocardiogram showed the ST segment ele-vation in lead aVR and ST-T wave changes in leads I, II and V4-6. Elevated D-dimer levels and cardi-ac enzymes were also observed. Acute myocardial infarction caused by the left main coronary artery obstruction was initial diagnosed. Coronary angiogram was performed immediately and the result indicated non-obstructive coronary artery. However, cardiogenic shock with persistent chest pain was discovered. Aortic dissection, pulmonary thromboembolism and cardiac tamponade were gradually excluded. Through detailed review and analysis of medical history, physical assessment and image ex-aminations with echocardiography, chest computed tomography and coronary angiogram, a ruptured sinus of Valsalva aneurysm was eventually diagnosed based on image examinations which revealed left-to-right shunt communicating with the right-sided heart chambers. The patient received emergen-cy right coronary sinus aneurysm repairment and aortic valve replacement surgery. Symptoms with chest pain and shock gradually disappeared and left ventricular function was restored postoperatively. The patient demonstrated excellent recovery. In facing relevance diagnostics for patients with acute chest pain and hemodynamic instability, a ruptured sinus of Valsalva aneurysm must be considered to endure best treatment timing if heart auscultation reveals S1 and S2 continuous murmurs.\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114216340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
台灣專科護理師學刊Pub Date : 2022-12-01DOI: 10.53106/2410325x2022120902004
劉嫈茹 劉嫈茹, 陳奐樺 Ying-Ju Liu
{"title":"發展輕度壓力性尿失禁婦女骨盆底肌強化訓練之臨床照護指引","authors":"劉嫈茹 劉嫈茹, 陳奐樺 Ying-Ju Liu","doi":"10.53106/2410325x2022120902004","DOIUrl":"https://doi.org/10.53106/2410325x2022120902004","url":null,"abstract":"\u0000 臨床上壓力性尿失禁常使用的評估診斷工具，可能造成輕度尿失禁症狀被低估而未適當治療，使病患仍受困擾。台灣健保制度完善，利用手術治療中、重度壓力性尿失禁病患，卻沒有對骨盆底肌強化訓練如何治療輕度壓力性尿失禁進行明確規範。本文發展流程為選定主題、建構問題、系統性文獻查證，根據16篇實證文獻擬定此指引，經由德菲法共識確認，隨後以AGREE II進行外部評估，結果為強烈建議使用，發展出指引範圍包含三個構面：指引的範圍界定5項，壓力性尿失禁評估診斷2項和處置建議5項。透過會議使醫師及專科護理師間達成共識；團隊成員教育訓練；建立檢核表，標準化評估處置流程，使輕度壓力性尿失禁婦女在身心完整評估下，適切接受骨盆底肌強化訓練。由於專科護理師跨醫療護理的角色功能，更能將此指引整合落實，使輕度壓力性尿失禁病患的照護更完整與持續。\u0000 The commonly used evaluation and diagnostic tools for clinical stress urinary incontinence may lead to underestimation of mild symptoms. Therefore, leaving patients with long-term distress when prop-erly treatment is not provided. Taiwan has a well-established health insurance system, of which sur-gery is used to treat patients with moderate to severe stress urinary incontinence, but there is no clear regulation on the use of pelvic floor muscle training to treat mild stress urinary incontinence. Through the selection of topics, construction of issues and comprehensive literature review, this guideline was developed based on 16 empirical studies. The content of this guideline was later confirmed by the Dephi method and was strongly recommended for application after externally evaluated by AGREEII. The scope of this guideline includes three facets: 5 items for scoping, 2 items for the assessment and diagnosis of stress urinary incontinence, and 5 items for treatment. Through meetings, consensus was reached between physicians and nurse practitioners; team members were educated and trained; a checklist was established to standardize the evaluation and treatment process, so that women with mild stress urinary incontinence could appropriately receive pelvic floor muscle training after a com-plete physical and mental evaluation. Since nurse practitioner plays an important role in medical care, this guideline can be integrated and implemented to comprehensively improve the care of patients with mild stress urinary incontinence.\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116060328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
台灣專科護理師學刊Pub Date : 2022-12-01DOI: 10.53106/2410325x2022120902007
陳思褕 陳思褕, 沈桂鳳 Szu-Yu Chen, 黃名秀 Kuei-Feng Shen
{"title":"一位60歲男性以反覆性腹脹表現","authors":"陳思褕 陳思褕, 沈桂鳳 Szu-Yu Chen, 黃名秀 Kuei-Feng Shen","doi":"10.53106/2410325x2022120902007","DOIUrl":"https://doi.org/10.53106/2410325x2022120902007","url":null,"abstract":"\u0000 結核性腹膜炎病程緩慢且症狀不具有專一性，當潛伏病灶再激活時其死亡率高。本案例是一位60歲男性患有腹脹疼痛、腹水合併發燒症狀，使用經驗性抗生素治療自發性腹膜炎後，其發燒逐漸緩和、但腹脹疼痛仍持續存在，因反覆性腹水增生與發燒症狀，考慮結核菌感染及惡性腫瘤之可能性，行電腦斷層檢查顯示腹膜有多處結節及浸潤，最終由腹腔鏡取得腹膜組織切片確診為結核性腹膜炎，隨即接受抗結核藥物治療，但病人於服藥四日後因併發急性肝衰竭而離世。面對腹脹、腹痛、反覆性腹水及發燒的病人，當抗生素治療成效不佳、臨床狀況與實驗室檢查值無法相呼應時，需將結核菌感染列為鑑別診斷，藉由詳細的身體評估、追蹤檢驗值及必要的切片病理輔助診斷，方能早期確立診斷，以免錯失最佳治療時機。\u0000 Tuberculous peritonitis is a slow developed disease with non-specific symptoms. When a latent tuber-culosis lesion is reactivated, its mortality rate is high. In this case, a 60-year-old man was presented with abdominal distension and tenderness. Intermittent fever and intra-abdominal ascites were also noted. After using empiric antibiotics with Imipenem 500 mg + Cilastatin sodium 500 mg to treat spontaneous peritonitis, his fever gradually subsided, but the abdominal distension and tenderness persisted. Due to recurrent ascites and fever, the possibility of tuberculosis infection and malignancy were highly suspected. Abdominal computerized tomography examination was arranged and revealed multiple nodules and infiltrations at the peritoneum. Laparoscopy surgical biopsy of peritoneal tissues were performed and the pathological reports confirmed the diagnosis of tuberculous peritonitis. The patient was treated with anti-tuberculosis drugs, but eventually expired due to acute liver failure four days after anti-tuberculosis drugs prescription. When a patient is presented with abdominal distension and tenderness accompanied with ascites and intermittent fever, antibiotics treatment is ineffective in corresponded to laboratory test data. Tuberculosis infection needs to be considered as one of the differential diagnosis. Detailed physical assessment, follow-up test values tracking and surgical biopsy can help establish an early diagnosis.\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115424629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
台灣專科護理師學刊Pub Date : 2022-12-01DOI: 10.53106/2410325x2022120902001
童恒新 童恒新, 蔡秀鸞 Heng-Hsin Tung
{"title":"科技導入專科護理師教育之臨床推理與批判性思維","authors":"童恒新 童恒新, 蔡秀鸞 Heng-Hsin Tung","doi":"10.53106/2410325x2022120902001","DOIUrl":"https://doi.org/10.53106/2410325x2022120902001","url":null,"abstract":"\u0000 疫後時代加成數位科技時代的熟度並廣泛運用在醫護教育。專科護理師（簡稱專師）與醫師共同提供病人最適當的照護。臨床推理與批判性思維是專師必備的進階專業照護能力，可透過教育訓練與臨床經驗堆疊漸階式達成臨床批判性思維。本文說明科技導入專科護理師教育之臨床推理批與判性思維訓練。首先，論述科技導入教育的優缺點。接續，陳述專科護理師教育之內涵，臨床推理的理論基礎與必要性。再者，如何將科技導入專科護理師教育之臨床批判性思維以利提升學習成效展演出接軌實務之核心能力。文末，筆者分享實際教學案例如何運用科技導入專科護理師教育之臨床推理與批判性思維。\u0000 In the post-epidemic era, the proficiency level of digital technology is rapidly improved and technol-ogy has been widely adopted in medical education. Nurse practitioners (referred to as NP) work with physicians to provide the most appropriate care for patients. Clinical reasoning and critical thinking are essential advanced professional skills for NPs, which can be acquired through education and clin-ical experience. This article describes the application of clinical reasoning and critical thinking train-ing technology on NPs’ education. First, the advantages and disadvantages of technology integration with education is introduced. Next, the content of NP education and the necessity of theoretical clini-cal reasoning is described. Furthermore, the ways to apply technology on the critical thinking in NPs’ education to improve the learning effect leading to demonstrating clinical competencies are discussed. At the end of the article, the author shares the applications of technology to facilitate clinical reason-ing and critical thinking in the curriculum of NPs’ education.\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"88 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128498204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
台灣專科護理師學刊Pub Date : 2022-12-01DOI: 10.53106/2410325x2022120902003
余怡珍 余怡珍
{"title":"淺談人工智慧於臨床健康照護之應用","authors":"余怡珍 余怡珍","doi":"10.53106/2410325x2022120902003","DOIUrl":"https://doi.org/10.53106/2410325x2022120902003","url":null,"abstract":"\u0000 醫療結合科技技術已是當前健康照護的趨勢，人工智慧在醫療領域的應用促成智慧醫療的發展，醫療照護也借助於各種科技技術的精進，讓疾病可以早期診斷、早期治療，更透過大數據收集與分析，輔助治療決策，增進醫療效率，走向精準醫療。智慧醫療可提供個人健康化管理進而達到高風險疾病預防，增進國人健康的福祉。不論是護理師或專科護理師都是醫療團隊面對病患的第一線醫療專業人員，護理臨床工作中對病患的身心評估、數據收集與完成各項健康紀錄是護理人員的重要職責，特別是專科護理師參與相關的醫療決策與治療計畫具有舉足輕重的角色，因此在現今人工智慧技術與醫療體系逐漸緊密結合的世代，護理人員若能對於科技技術有更深入的了解，將可增進與醫療團隊的溝通，參與更多的醫療決策並提升護理功能與照護品質。本文將介紹科技技術的初步概念及臨床護理的應用，期能提供專科護理師或護理人員未來在臨床照護或研究方面的參考。\u0000 Technological innovation is currently the mainstream in medical care industry. Specifically, artificialintelligence (AI) has become a critical role in medical care, as it can facilitate early diagnosis and treatment. The collection and analysis of big data can assist in decision making and improving med-ical efficiency. Moreover, this technology can be used to improve personal health management and to prevent high-risk disease and enhance overall health and wellbeing. Nursing staff are the first-line medical care professionals who interact with patients directly. Nurses are expected to carry out full medical assessments of patients, collecting data and recording various electronic health information. Nurse Practitioners play a pivotal role in medical decision-making process by developing treatment plans. As such, given the capabilities of AI and its prevalence within healthcare, understanding this technology and the ways to utilize it, is key to improve interprofessional communication, to facilitate the medical decision-making process and to increase quality of care. This article will introduce the application of AI in nursing and, by extension, provide a starting point for nurses and nurse practi-tioners to better understand its role in clinical care and research.\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121767560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
台灣專科護理師學刊Pub Date : 2022-12-01DOI: 10.53106/2410325x2022120902010
謝馴梅 謝馴梅, 吳冠陞 Hsun-Mei Shieh
{"title":"一位以頭痛一個月為表徵的43歲男性","authors":"謝馴梅 謝馴梅, 吳冠陞 Hsun-Mei Shieh","doi":"10.53106/2410325x2022120902010","DOIUrl":"https://doi.org/10.53106/2410325x2022120902010","url":null,"abstract":"\u0000 頭痛是臨床常見的主訴，雖然絕大多數的頭痛具自限性病程，卻也可能是中樞神經系統感染的初始症狀之一，此時若未能及時診斷治療，會導致病人有較高的風險發生永久性神經功能缺損、甚至造成死亡。本案例描述一位43歲男性，主訴入院前一個月開始出現發燒及持續性頭頂鈍痛症狀，尤其清晨睡醒時頭痛最為劇烈，入院前一周頭痛加劇，並出現複視、雙下肢麻痛等症狀。到院時意識清楚，身體檢查發現右眼無法外旋，腦部影像正常，腦脊髓液中白血球及淋巴球比例皆異常增多，血清中嗜伊紅性白血球比例偏高。詳問病史發現病人於頭痛前五天曾生食青蛙，以酵素結合免疫吸附法檢驗腦脊髓液及血清後發現有廣東住血線蟲之抗體，診斷為廣東住血線蟲引起之嗜伊紅性腦膜炎。經治療後病人恢復良好，頭痛發燒皆已解除，惟右眼仍無法完全外旋。本案例提醒我們：當遇到淋巴球性腦膜炎，合併血清或腦脊髓液中嗜伊紅性球比例異常偏高時，需主動詢問發病前之飲食狀況，以判斷是否有食入遭寄生蟲汙染之食物與飲水之可能性。\u0000 Headache is a common clinical complaint mostly with a self-limited course but may also be a symp-tom of central nervous system infection. If the diagnosis is not established in time, permanent neu-rological deficits and even death may occur. We presented a 43-year-old man who had fever and per-sistent dull pain in the top of the head as symptoms for a month before admission, especially the most severe headache when waking up in the morning. The headache got worsened, diplopia and bilateral lower extremities numbness were noticed one week before admission. Despite several visits to a local clinic, no definite diagnosis was made. On admission, the patient was conscious. However, he was un-able to rotate his right eye internally. The brain images showed no abnormality. A cerebrospinal fluid examination suggested that the lymphocytic meningitis and serum eosinophils levels were higher than expected. After a thorough medical history inquiry, we found out that the patient ate raw frogs five days before the headache was occurred. Enzyme-linked immunosorbent assays identified antibodies to Angiostrongylus cantonensis in his cerebrospinal fluid and serum. Eosinophilic meningitis caused by Angiostrongylus cantonensis was therefore diagnosed. The patient recovered smoothly after a four-month treatment with a minor sequelae symptom remaining. This case reminds us that when encoun-tering lymphocytic meningitis and the proportion of eosinophils in serum or cerebrospinal fluid is abnormally high, it is necessary to take the initiative to inquire about the dietary history to determine whether there are ingested parasites potential from contaminated food and drinking water.\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123409986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
求助内容：
应助结果提醒方式：