一位紅斑性狼瘡併發腮腺炎學齡期兒童之護理經驗

本個案報告探討一位全身紅斑狼瘡併發腮腺炎的學齡期兒童，住院期間以語言及非語言方式表達需要及感受的護理過程。筆者為個案主護護理師，採觀察、會談方式及Gordon十一項功能性健康型態評估其生理心理的需要，將所得之資料加以整理分析。結果顯示個案於住院其間主要護理問題為〈一〉白球低下所致之高危險性感染〈二〉關節肌肉酸痛所致之活動無耐力〈三〉嘔吐所致之營養少於身體需要〈四〉疾病及治療所致之身體心像改變。筆者藉由〈一〉嚴密性的預防隔離措施〈二〉熱敷、按摩酸痛之關節〈三〉飲食衛教以改善其感染、疼痛、營養之生理問題，而身體心像之改變則藉由遊戲方式、同理心之應用，與個案建立良好之護病關係，引導及鼓勵其說出心中之感受，使個案由沉默不語轉為主動參與護理計劃的正向行為。
This case report aimed to explore the nursing process for a school -aged child with SLE complicated with mumps who verbally and nonverbally expressed his need and feeling during hospitalization. As his primary nurse, the author observed and interviewed the child to assess his physiological and psychological needs based on the Gordon 11 functional health patterns. The primary nursing problems the child had Were (1) high risk infection due to leukocytopenia, (2) activity intolerance due to joint and muscle soreness, (3) altered nutrition less than body requirement due to vomiting, and (4) body image change due to illness and treatment. Absolute protective isolation, massage with warm application, and diet instruction have prevented him from infection and relived him from pain, and improved nutrition status. The author used therapeutic play and empathy to establish therapeutic nurse-patient relationship and encouraged the child to express his feeling. As a result, the child broke his silence and turned to spontaneously participate in nursing care.