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
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.
胰脏炎、脂膜炎与多发性关节炎症候群（pancreatitis, panniculitis, and polyarthritis, PPP）是胰脏疾病患者罕见发生于肢体的合并症。虽然PPP症候群罕见，当延迟诊断或缺乏胰脏炎治疗时会导致高死亡率。本个案为53岁男性胰脏炎史，此次因右小腿长期反复发红性皮疹肿胀和复发性双膝关节炎，经相关检查后诊断为右小腿脓疡与多发性膝关节炎住院，于施行右小腿手术中发现与组织病理报告皆有脂膜炎病征之异常呈现；虽然个案无腹部不适主诉，但回溯先前腹部电脑断层有渗出性胰脏炎发现，因此于治疗后期诊断为PPP症候群，持续给予适当抗生素和抗胰脏炎药物治疗使症状获得改善。因此当临床遇见中年男性胰脏病史患者、伴随反复性下肢肿胀、发红性皮疹和复发性膝关节炎症状，则胰脏炎、脂膜炎与多发性关节炎症候群就必须列入考虑，以避免错失治疗先机。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.
{"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}
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。 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.
发烧是相当普遍的症状表现，但后续评估厘清原因，并尽早确认诊断治疗更是临床一大考验。本案是一位67岁男性，因两周前反复发烧合并寒颤、腹痛、全身酸痛，外院诊断泌尿道感染口服抗生素治疗无效，因两天前并发呼吸喘及头痛就医，本院急诊初步诊断败血性休克合并多重器官衰竭入院治疗。笔者为感染科专师，照护期间为2019 年11月12日至12月10日，经详细病史询问及身体评估，因个案有猴子咬伤接触史，医疗团队初步疑似恙虫病合并钩端螺旋体感染，立即开立恙虫病及钩端螺旋体检验并同步给予两种抗生素治疗，于2019 年11月27日确诊恙虫病，治疗后感染及败血性休克得以控制，呼吸、肠胃、肝肾功能逐渐恢复改善，个案顺利健康出院。针对反复发烧为表现之患者，必须仔细询问职业史、旅游史、接触史及群聚史，当个案属于恙虫病高风险感染族群时，即使未发现焦痂，在流行区仍须将恙虫病列为鉴别诊断，以免错失治疗时机。 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.
{"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}
Pub Date : 2022-12-01DOI: 10.53106/2410325x2022120902009
許瑞芸 許瑞芸, 周怡伶 Jui-Yun Hsu
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。 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.
急性间歇性紫质症是一种罕见的遗传性代谢异常疾病。本案例是一位38岁女性病人，起初反复性腹痛合并恶心、呕吐、腹泻之表现，后续发生癫痫大发作及急性呼吸衰竭，经实验室检验及影像检查，仅呈现低血钠、白血球增加，其他无异常发现。由于发现尿液偏褐色，进一步检验发现尿液中高胺基酮戊酸、高胆色素原，以及血液中低胆色素原脱胺酶，确诊急性间歇性紫质症，经血基质治疗后临床症状逐渐改善并顺利出院。针对此类以腹痛合并癫痫表现的病人，且与低血钠之征象并存时，必须将急性紫质症列为鉴别诊断之一，以免延误治疗时机。 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.
{"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}
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。 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.
Z世代（又称I Generation）的学生成长于网路科技快速发展的环境，习惯依赖网路来搜寻资讯，学习偏向视听刺激，较不喜欢阅读或聆听讲述。近年来行动应用程式在教育的领域中使用频率越来越多，学生可以透过行动应用程式随时随地取用各种学习资讯。行动应用程式（App）应用到护理教学中，不仅能符合学生的学习需求，更可提高学习成效。多数App设计都是要写程式，护理教师只能提供课程专业知识 （know how），其App相关内容则需要仰赖科技人设计，设计成本贵，大多需要倚赖经费支援。本文将从行动应用程式谈起，说明制作免编程App的操作技巧，探讨其优点与限制，同时说明护理教育者如何在有限的资源下，制作一个创新有趣的行动应用程式App。期望未来护理教育者能发展出一个专属自己的行动学习App，激发学生学习动机，提升学习成效。 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.
{"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}
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
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。 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.
主动脉窦动脉瘤是一种罕见的心脏结构病变，因具非特异性表征及困难诊断，容易导致高死亡风险。本案例是一位53岁男性患者，因急性胸痛入院治疗，借由实验室检查发现心肌酵素升高、D-二聚体升高，心电图检查为aVR导程ST段上升、于第I、II、V4~6导程出现ST-T波段变化，初步诊断为左冠状动脉主干心肌梗塞，立即行冠状动脉摄影检查发现无异常。个案出现胸痛合并心因性休克之症状，从中排除主动脉剥离、肺栓塞、心包填塞等诊断，深入检视病史纪录及影像报告，发现心脏超音波、胸部电脑断层及冠状动脉血管摄影检查有由左流向右心室的瘘管分流，最终确诊为主动脉窦动脉瘤破裂。患者紧急接受右冠状窦动脉瘤修补及主动脉瓣置换手术治疗后，胸痛、休克状况改善且左心室功能恢复，术后预后良好。在面对急性胸痛合并血液动力学不稳定的患者时，除了须考虑症状相关的疾病诊断外，当听诊发现S1及S2连续性心杂音时，建议将主动脉窦动脉瘤破裂列入考虑，以掌握治疗处置之重要时机。 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.
{"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}
Pub Date : 2022-12-01DOI: 10.53106/2410325x2022120902004
劉嫈茹 劉嫈茹, 陳奐樺 Ying-Ju Liu
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。 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.
临床上压力性尿失禁常使用的评估诊断工具，可能造成轻度尿失禁症状被低估而未适当治疗，使病患仍受困扰。台湾健保制度完善，利用手术治疗中、重度压力性尿失禁病患，却没有对骨盆底肌强化训练如何治疗轻度压力性尿失禁进行明确规范。本文发展流程为选定主题、建构问题、系统性文献查证，根据16篇实证文献拟定此指引，经由德菲法共识确认，随后以AGREE II进行外部评估，结果为强烈建议使用，发展出指引范围包含三个构面：指引的范围界定5项，压力性尿失禁评估诊断2项和处置建议5项。透过会议使医师及专科护理师间达成共识；团队成员教育训练；建立检核表，标准化评估处置流程，使轻度压力性尿失禁妇女在身心完整评估下，适切接受骨盆底肌强化训练。由于专科护理师跨医疗护理的角色功能，更能将此指引整合落实，使轻度压力性尿失禁病患的照护更完整与持续。 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.
{"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}
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
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。 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.
结核性腹膜炎病程缓慢且症状不具有专一性，当潜伏病灶再激活时其死亡率高。本案例是一位60岁男性患有腹胀疼痛、腹水合并发烧症状，使用经验性抗生素治疗自发性腹膜炎后，其发烧逐渐缓和、但腹胀疼痛仍持续存在，因反复性腹水增生与发烧症状，考虑结核菌感染及恶性肿瘤之可能性，行电脑断层检查显示腹膜有多处结节及浸润，最终由腹腔镜取得腹膜组织切片确诊为结核性腹膜炎，随即接受抗结核药物治疗，但病人于服药四日后因并发急性肝衰竭而离世。面对腹胀、腹痛、反复性腹水及发烧的病人，当抗生素治疗成效不佳、临床状况与实验室检查值无法相呼应时，需将结核菌感染列为鉴别诊断，借由详细的身体评估、追踪检验值及必要的切片病理辅助诊断，方能早期确立诊断，以免错失最佳治疗时机。 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.
{"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}
Pub Date : 2022-12-01DOI: 10.53106/2410325x2022120902001
童恒新 童恒新, 蔡秀鸞 Heng-Hsin Tung
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。 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.
疫后时代加成数位科技时代的熟度并广泛运用在医护教育。专科护理师（简称专师）与医师共同提供病人最适当的照护。临床推理与批判性思维是专师必备的进阶专业照护能力，可透过教育训练与临床经验堆叠渐阶式达成临床批判性思维。本文说明科技导入专科护理师教育之临床推理批与判性思维训练。首先，论述科技导入教育的优缺点。接续，陈述专科护理师教育之内涵，临床推理的理论基础与必要性。再者，如何将科技导入专科护理师教育之临床批判性思维以利提升学习成效展演出接轨实务之核心能力。文末，笔者分享实际教学案例如何运用科技导入专科护理师教育之临床推理与批判性思维。 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.
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Pub Date : 2022-12-01DOI: 10.53106/2410325x2022120902003
余怡珍 余怡珍
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。 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.
医疗结合科技技术已是当前健康照护的趋势，人工智慧在医疗领域的应用促成智慧医疗的发展，医疗照护也借助于各种科技技术的精进，让疾病可以早期诊断、早期治疗，更透过大数据收集与分析，辅助治疗决策，增进医疗效率，走向精准医疗。智慧医疗可提供个人健康化管理进而达到高风险疾病预防，增进国人健康的福祉。不论是护理师或专科护理师都是医疗团队面对病患的第一线医疗专业人员，护理临床工作中对病患的身心评估、数据收集与完成各项健康纪录是护理人员的重要职责，特别是专科护理师参与相关的医疗决策与治疗计划具有举足轻重的角色，因此在现今人工智慧技术与医疗体系逐渐紧密结合的世代，护理人员若能对于科技技术有更深入的了解，将可增进与医疗团队的沟通，参与更多的医疗决策并提升护理功能与照护品质。本文将介绍科技技术的初步概念及临床护理的应用，期能提供专科护理师或护理人员未来在临床照护或研究方面的参考。 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.
{"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}
Pub Date : 2022-12-01DOI: 10.53106/2410325x2022120902010
謝馴梅 謝馴梅, 吳冠陞 Hsun-Mei Shieh
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。 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.
头痛是临床常见的主诉，虽然绝大多数的头痛具自限性病程，却也可能是中枢神经系统感染的初始症状之一，此时若未能及时诊断治疗，会导致病人有较高的风险发生永久性神经功能缺损、甚至造成死亡。本案例描述一位43岁男性，主诉入院前一个月开始出现发烧及持续性头顶钝痛症状，尤其清晨睡醒时头痛最为剧烈，入院前一周头痛加剧，并出现复视、双下肢麻痛等症状。到院时意识清楚，身体检查发现右眼无法外旋，脑部影像正常，脑脊髓液中白血球及淋巴球比例皆异常增多，血清中嗜伊红性白血球比例偏高。详问病史发现病人于头痛前五天曾生食青蛙，以酵素结合免疫吸附法检验脑脊髓液及血清后发现有广东住血线虫之抗体，诊断为广东住血线虫引起之嗜伊红性脑膜炎。经治疗后病人恢复良好，头痛发烧皆已解除，惟右眼仍无法完全外旋。本案例提醒我们：当遇到淋巴球性脑膜炎，合并血清或脑脊髓液中嗜伊红性球比例异常偏高时，需主动询问发病前之饮食状况，以判断是否有食入遭寄生虫污染之食物与饮水之可能性。 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.
{"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}
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