Pub Date : 2022-06-01DOI: 10.53106/2410325x2022060901001
謝提諾 謝提諾, 邱曉彥 Ti-No Hsieh
醫療科技日新月異，不變的是人們對高質量照護的需求，實踐實證照護為提升護理照護品質的途徑之一。本文將概述實證護理之演進、闡釋能堪任醫療及護理的專科護理師於實證應用之角色與阻滯，及專科護理師教育之革新。最後，結合文末實際臨床情境之分享，期待本文可讓專科護理師瞭解實證在專科護理師實務上之應用，更進一步認同且致力實踐實證護理，以提升照護品質， 強化專科護理師在健康照護體系之定位，體現專業角色之獨特與重要性 In the era of rapidly advancing medical technology, the matter remains unchanged is people’s demand for high-quality care. The practice of evidence-based care is one of the ways to improve the quality of nursing care. This article outlines the evolution of evidence-based nursing, elaborates the role and impediment to the application of evidence-based nursing by nurse practitioners, and the revolution of professional nurse practitioners’ education was discussed. At the end of the article, two actual clinical cases were presented. Through the case studies, we expect that nurse practitioners can understand the application of evidence-based nursing in clinical settings and further to recognize and devote themselves to practicing evidence-based nursing, for improving the quality of care and strengthening the role of nurse practitioners in the health care system
医疗科技日新月异，不变的是人们对高质量照护的需求，实践实证照护为提升护理照护品质的途径之一。本文将概述实证护理之演进、阐释能堪任医疗及护理的专科护理师于实证应用之角色与阻滞，及专科护理师教育之革新。最后，结合文末实际临床情境之分享，期待本文可让专科护理师了解实证在专科护理师实务上之应用，更进一步认同且致力实践实证护理，以提升照护品质， 强化专科护理师在健康照护体系之定位，体现专业角色之独特与重要性 In the era of rapidly advancing medical technology, the matter remains unchanged is people’s demand for high-quality care. The practice of evidence-based care is one of the ways to improve the quality of nursing care. This article outlines the evolution of evidence-based nursing, elaborates the role and impediment to the application of evidence-based nursing by nurse practitioners, and the revolution of professional nurse practitioners’ education was discussed. At the end of the article, two actual clinical cases were presented. Through the case studies, we expect that nurse practitioners can understand the application of evidence-based nursing in clinical settings and further to recognize and devote themselves to practicing evidence-based nursing, for improving the quality of care and strengthening the role of nurse practitioners in the health care system
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Pub Date : 2022-06-01DOI: 10.53106/2410325x2022060901003
林慈珍 林慈珍, 周信旭 Tzu-Chen Lin, 蔡惠如 Hsin-His Chou
超過六成血液透析病人，曾因自體瘻管障礙及失效需外科介入進行瘻管重建術，倘若無良好的預防措施及追蹤，病人瘻管需再次行外科手術的比率上升，進而增加醫療成本的耗損。本指引透過五個階段建置「以非外科介入預防透析病人自體瘻管失效之臨床照護指引」，第一階段成立指引發展小組；第二階段進行2018年前的文獻搜尋及評讀，共篩選出17篇文獻；第三階段依據2015 年蘇格蘭指引發展組織（Scottish Intercollegiate Guidelines Network, SIGN）之證據等級評定各項指引之建議強度，共建置內含23項目之處置初稿（未含指引範圍界定）；第四階段邀請10位臨床相關領域專家，進行處置初稿之專家效度分析及修改；第五階段邀請46位臨床照護人員、及10位透析病人進行指引之可行性調查，最後完成具有21項目的指引處置內容。本指引共包含五個構面：指引範圍界定4項、藥物在自體瘻管失效上的預防3項、透析治療中的照護措施6項、居家照護要點4項，及常規追蹤與處置8項，共25 個項目。期許本指引能協助血液透析病人預防自體瘻管失效，以降低廔管手術重建率，進而減少醫療成本的耗費 More than 60% of hemodialysis patients need surgical interventions for arteriovenous fistula stenosis or failure. Without adequate preventive treatments and follow-up actions, a high surgery rate resulting in increased medical costs is anticipated. The “ Clinical Care Guidelines of Non-Surgical Interven¬tions to Prevent Arteriovenous Fistula Failure” were developed through the following five phases. In phase one, a team was established for developing guidelines. In phase two, team members searched published literature before 2018 and identified seventeen related articles. In phase three, the level of evidence according to the 2015 Scottish Intercollegiate Guidelines Network (SIGN) was evaluated. The first draft of the clinical guidelines included 23 items (the scope of the guidelines remaining un¬defined). In phase four, expert validity of the draft was assessed by 10 clinical experts. In phase five, 46 clinicians and 10 hemodialysis patients were invited to evaluate the feasibility of the guidelines, and 21 items were selected for the final version of the guidelines. The clinical care guidelines consist¬ed of 5 constructs with a total of 25 items, including the scope of the guidelines (4 items), pharmaco¬logical treatments for arteriovenous fistula failure (3 items), nursing measures during hemodialysis (6 items), home care measures (4 items), and routine follow-up and management (8 items). With the development of the guidelines, we expect to lower the reconstruction rate of arteriovenous fistula and reduce medical costs through the prevention of arteriovenous fistula failure in hemodialysis patients
超过六成血液透析病人，曾因自体瘘管障碍及失效需外科介入进行瘘管重建术，倘若无良好的预防措施及追踪，病人瘘管需再次行外科手术的比率上升，进而增加医疗成本的耗损。本指引透过五个阶段建置「以非外科介入预防透析病人自体瘘管失效之临床照护指引」，第一阶段成立指引发展小组；第二阶段进行2018年前的文献搜寻及评读，共筛选出17篇文献；第三阶段依据2015 年苏格兰指引发展组织（Scottish Intercollegiate Guidelines Network, SIGN）之证据等级评定各项指引之建议强度，共建置内含23项目之处置初稿（未含指引范围界定）；第四阶段邀请10位临床相关领域专家，进行处置初稿之专家效度分析及修改；第五阶段邀请46位临床照护人员、及10位透析病人进行指引之可行性调查，最后完成具有21项目的指引处置内容。本指引共包含五个构面：指引范围界定4项、药物在自体瘘管失效上的预防3项、透析治疗中的照护措施6项、居家照护要点4项，及常规追踪与处置8项，共25 个项目。期许本指引能协助血液透析病人预防自体瘘管失效，以降低廔管手术重建率，进而减少医疗成本的耗费 More than 60% of hemodialysis patients need surgical interventions for arteriovenous fistula stenosis or failure. Without adequate preventive treatments and follow-up actions, a high surgery rate resulting in increased medical costs is anticipated. The “ Clinical Care Guidelines of Non-Surgical Interven¬tions to Prevent Arteriovenous Fistula Failure” were developed through the following five phases. In phase one, a team was established for developing guidelines. In phase two, team members searched published literature before 2018 and identified seventeen related articles. In phase three, the level of evidence according to the 2015 Scottish Intercollegiate Guidelines Network (SIGN) was evaluated. The first draft of the clinical guidelines included 23 items (the scope of the guidelines remaining un¬defined). In phase four, expert validity of the draft was assessed by 10 clinical experts. In phase five, 46 clinicians and 10 hemodialysis patients were invited to evaluate the feasibility of the guidelines, and 21 items were selected for the final version of the guidelines. The clinical care guidelines consist¬ed of 5 constructs with a total of 25 items, including the scope of the guidelines (4 items), pharmaco¬logical treatments for arteriovenous fistula failure (3 items), nursing measures during hemodialysis (6 items), home care measures (4 items), and routine follow-up and management (8 items). With the development of the guidelines, we expect to lower the reconstruction rate of arteriovenous fistula and reduce medical costs through the prevention of arteriovenous fistula failure in hemodialysis patients
{"title":"非外科介入預防自體瘻管失效之臨床照護指引","authors":"林慈珍 林慈珍, 周信旭 Tzu-Chen Lin, 蔡惠如 Hsin-His Chou","doi":"10.53106/2410325x2022060901003","DOIUrl":"https://doi.org/10.53106/2410325x2022060901003","url":null,"abstract":"\u0000 超過六成血液透析病人，曾因自體瘻管障礙及失效需外科介入進行瘻管重建術，倘若無良好的預防措施及追蹤，病人瘻管需再次行外科手術的比率上升，進而增加醫療成本的耗損。本指引透過五個階段建置「以非外科介入預防透析病人自體瘻管失效之臨床照護指引」，第一階段成立指引發展小組；第二階段進行2018年前的文獻搜尋及評讀，共篩選出17篇文獻；第三階段依據2015 年蘇格蘭指引發展組織（Scottish Intercollegiate Guidelines Network, SIGN）之證據等級評定各項指引之建議強度，共建置內含23項目之處置初稿（未含指引範圍界定）；第四階段邀請10位臨床相關領域專家，進行處置初稿之專家效度分析及修改；第五階段邀請46位臨床照護人員、及10位透析病人進行指引之可行性調查，最後完成具有21項目的指引處置內容。本指引共包含五個構面：指引範圍界定4項、藥物在自體瘻管失效上的預防3項、透析治療中的照護措施6項、居家照護要點4項，及常規追蹤與處置8項，共25 個項目。期許本指引能協助血液透析病人預防自體瘻管失效，以降低廔管手術重建率，進而減少醫療成本的耗費\u0000 More than 60% of hemodialysis patients need surgical interventions for arteriovenous fistula stenosis or failure. Without adequate preventive treatments and follow-up actions, a high surgery rate resulting in increased medical costs is anticipated. The “ Clinical Care Guidelines of Non-Surgical Interven¬tions to Prevent Arteriovenous Fistula Failure” were developed through the following five phases. In phase one, a team was established for developing guidelines. In phase two, team members searched published literature before 2018 and identified seventeen related articles. In phase three, the level of evidence according to the 2015 Scottish Intercollegiate Guidelines Network (SIGN) was evaluated. The first draft of the clinical guidelines included 23 items (the scope of the guidelines remaining un¬defined). In phase four, expert validity of the draft was assessed by 10 clinical experts. In phase five, 46 clinicians and 10 hemodialysis patients were invited to evaluate the feasibility of the guidelines, and 21 items were selected for the final version of the guidelines. The clinical care guidelines consist¬ed of 5 constructs with a total of 25 items, including the scope of the guidelines (4 items), pharmaco¬logical treatments for arteriovenous fistula failure (3 items), nursing measures during hemodialysis (6 items), home care measures (4 items), and routine follow-up and management (8 items). With the development of the guidelines, we expect to lower the reconstruction rate of arteriovenous fistula and reduce medical costs through the prevention of arteriovenous fistula failure in hemodialysis patients\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"2040 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129786492","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}
慢性血栓栓塞性肺高壓是一種罕見、嚴重且持續惡化的肺部血管性疾病，隨病程進展，致死率極高，儘早鑑別診斷，方能提供準確治療計劃。本文是一位67歲女性案例，因活動呼吸喘就醫， 初步臆斷為心臟衰竭合併急性惡化，入院後藉由病史詢問、檢驗及理學檢查結果顯示BNP持續上升且心電圖呈現S1Q3T3，初步懷疑可能有肺栓塞併心衰竭，故安排心臟超音波檢查，結果發現有肺動脈高壓（肺動脈壓：62.3 mmHg）與右心衰竭，安排胸部電腦斷層攝影，顯示肺動脈栓塞，隨即召開家庭會議解釋病情後，接受右心導管合併肺動脈血管攝影檢查，最終確診為遠端型慢性血栓栓塞性肺高壓併右心衰竭。經由醫療團隊評估後，治療計劃即以藥物為主，故協助申請標靶藥物Riociguat。針對此類病人，即便臨床表徵不具特異性，仍可依病史詢問、檢驗及理學檢查預測肺栓塞的可能性，之後進入影像學鑑別診斷。換言之，雖然慢性血栓栓塞性肺高壓有其高致命的危險性，倘若能及早做出診斷與治療，便能降低死亡風險。 Chronic thromboembolic pulmonary hypertension is a rare, severe and continuous deterioration of pulmonary vascular disease which has high mortality rate along with disease progression. Earlier diagnosis could contribute to a more accurate treatment plan. A case of 67-year-old female was admitted to hospital because of exertional dyspnea. She was initially suffering from heart failure with acute deterioration. After admission, the results of medical history inquiry, laboratory data and physical examination revealed that BNP level kept raising and the electrocardiogram showed S1Q3T3, which pulmonary embolism with heart failure was suspected. Therefore, echocardiography revealed pulmonary hypertension (pulmonary artery pressure: 62.3 mmHg) and right heart failure. Pulmonary embolism was noticed on chest computed tomography. Soon after the family meeting of medical condition discussion, the patient received right heart catheterization combined with pulmonary artery angiography, and the final diagnosed is distal chronic thromboembolic pulmonary hypertension with right heart failure. After medical team’s assessment, the treatment plan was based on armaceutical control. Thus, the target therapy of Riociguat was performed. For such type of patients, even with non-specific symptoms, the possibility of pulmonary embolism can still be predicted based on medical history, laboratory data, physical examination, and the imaging differential diagnosis. If diagnosis and treatment can be conducted as early as possible, the high mortality rate of chronic hromboembolic pulmonary hypertension can be reduced.
慢性血栓栓塞性肺高压是一种罕见、严重且持续恶化的肺部血管性疾病，随病程进展，致死率极高，尽早鉴别诊断，方能提供准确治疗计划。本文是一位67岁女性案例，因活动呼吸喘就医， 初步臆断为心脏衰竭合并急性恶化，入院后借由病史询问、检验及理学检查结果显示BNP持续上升且心电图呈现S1Q3T3，初步怀疑可能有肺栓塞并心衰竭，故安排心脏超音波检查，结果发现有肺动脉高压（肺动脉压：62.3 mmHg）与右心衰竭，安排胸部电脑断层摄影，显示肺动脉栓塞，随即召开家庭会议解释病情后，接受右心导管合并肺动脉血管摄影检查，最终确诊为远端型慢性血栓栓塞性肺高压并右心衰竭。经由医疗团队评估后，治疗计划即以药物为主，故协助申请标靶药物Riociguat。针对此类病人，即便临床表征不具特异性，仍可依病史询问、检验及理学检查预测肺栓塞的可能性，之后进入影像学鉴别诊断。换言之，虽然慢性血栓栓塞性肺高压有其高致命的危险性，倘若能及早做出诊断与治疗，便能降低死亡风险。 Chronic thromboembolic pulmonary hypertension is a rare, severe and continuous deterioration of pulmonary vascular disease which has high mortality rate along with disease progression. Earlier diagnosis could contribute to a more accurate treatment plan. A case of 67-year-old female was admitted to hospital because of exertional dyspnea. She was initially suffering from heart failure with acute deterioration. After admission, the results of medical history inquiry, laboratory data and physical examination revealed that BNP level kept raising and the electrocardiogram showed S1Q3T3, which pulmonary embolism with heart failure was suspected. Therefore, echocardiography revealed pulmonary hypertension (pulmonary artery pressure: 62.3 mmHg) and right heart failure. Pulmonary embolism was noticed on chest computed tomography. Soon after the family meeting of medical condition discussion, the patient received right heart catheterization combined with pulmonary artery angiography, and the final diagnosed is distal chronic thromboembolic pulmonary hypertension with right heart failure. After medical team’s assessment, the treatment plan was based on armaceutical control. Thus, the target therapy of Riociguat was performed. For such type of patients, even with non-specific symptoms, the possibility of pulmonary embolism can still be predicted based on medical history, laboratory data, physical examination, and the imaging differential diagnosis. If diagnosis and treatment can be conducted as early as possible, the high mortality rate of chronic hromboembolic pulmonary hypertension can be reduced.
{"title":"以活動喘表現之慢性血栓栓塞性肺高壓：病例報告","authors":"江彥萩 江彥萩, 李月麗 Yen-Chiu Chiang, 黃名秀 Yueh-Lih Li, 潘慧娟 Ming-Hsiu Huang, 沈桂鳳 Hui-Chuan Pan","doi":"10.53106/2410325x2022060901006","DOIUrl":"https://doi.org/10.53106/2410325x2022060901006","url":null,"abstract":"\u0000 慢性血栓栓塞性肺高壓是一種罕見、嚴重且持續惡化的肺部血管性疾病，隨病程進展，致死率極高，儘早鑑別診斷，方能提供準確治療計劃。本文是一位67歲女性案例，因活動呼吸喘就醫， 初步臆斷為心臟衰竭合併急性惡化，入院後藉由病史詢問、檢驗及理學檢查結果顯示BNP持續上升且心電圖呈現S1Q3T3，初步懷疑可能有肺栓塞併心衰竭，故安排心臟超音波檢查，結果發現有肺動脈高壓（肺動脈壓：62.3 mmHg）與右心衰竭，安排胸部電腦斷層攝影，顯示肺動脈栓塞，隨即召開家庭會議解釋病情後，接受右心導管合併肺動脈血管攝影檢查，最終確診為遠端型慢性血栓栓塞性肺高壓併右心衰竭。經由醫療團隊評估後，治療計劃即以藥物為主，故協助申請標靶藥物Riociguat。針對此類病人，即便臨床表徵不具特異性，仍可依病史詢問、檢驗及理學檢查預測肺栓塞的可能性，之後進入影像學鑑別診斷。換言之，雖然慢性血栓栓塞性肺高壓有其高致命的危險性，倘若能及早做出診斷與治療，便能降低死亡風險。\u0000 Chronic thromboembolic pulmonary hypertension is a rare, severe and continuous deterioration of pulmonary vascular disease which has high mortality rate along with disease progression. Earlier diagnosis could contribute to a more accurate treatment plan. A case of 67-year-old female was admitted to hospital because of exertional dyspnea. She was initially suffering from heart failure with acute deterioration. After admission, the results of medical history inquiry, laboratory data and physical examination revealed that BNP level kept raising and the electrocardiogram showed S1Q3T3, which pulmonary embolism with heart failure was suspected. Therefore, echocardiography revealed pulmonary hypertension (pulmonary artery pressure: 62.3 mmHg) and right heart failure. Pulmonary embolism was noticed on chest computed tomography. Soon after the family meeting of medical condition discussion, the patient received right heart catheterization combined with pulmonary artery angiography, and the final diagnosed is distal chronic thromboembolic pulmonary hypertension with right heart failure. After medical team’s assessment, the treatment plan was based on armaceutical control. Thus, the target therapy of Riociguat was performed. For such type of patients, even with non-specific symptoms, the possibility of pulmonary embolism can still be predicted based on medical history, laboratory data, physical examination, and the imaging differential diagnosis. If diagnosis and treatment can be conducted as early as possible, the high mortality rate of chronic hromboembolic pulmonary hypertension can be reduced.\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"193 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133751289","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}
胸痛為臨床常見主述，在排除心因性問題後，常因病人合併胃灼熱感，診斷為胃食道逆流。然而本案例為一位36歲女性，因反覆進食後胸痛、胃灼熱及逆流等症狀，依醫囑斷續服用氫離子幫浦抑制劑（Proton Pump Inhibitor, PPI）治療胃食道逆流約一年仍未改善，直至夜間逆流咳嗽加劇，轉至本院消化內科求治，問診後發現合併有吞嚥困難及體重減輕情形，安排上消化道內視鏡排除食道腫瘤後，經食道攝影檢查確診為食道弛緩不能症（achalasia）。個案接受經口內視鏡肌層切開術治療、營養重建及心理諮商後，胸痛、逆流及吞嚥困難等症狀大幅改善，體重也從44 kg回復至50 kg，焦慮程度亦漸緩解。針對反覆出現與胃食道逆流相似症狀，或經藥物治療無效者，應進一步評估有無吞嚥困難，與胃食道逆流作鑑別診斷，避免病人因進食困難，造成營養不良併發症，以及長期睡眠困擾導致負向情緒感受，嚴重影響生活品質。 Chest pain as a relatively common clinical symptom especially when excluding ischemic heart disease, patients are often diagnosed with gastroesophageal reflux disease due to acid regurgitation and a sensation of heartburn. A 36-year-old woman had had been intermittently treated with an oral proton pump inhibitor (PPI) under the impression of gastroesophageal reflux disease for approximately one year due to recurrent chest pain, heartburn, and a sensation of regurgitation. However, the symptoms deteriorated with exacerbation at night, which was an indication of poor response to the oral medication. Thus, she was transferred to the Department of Gastroenterology for further examination and treatment. After detailed inquiry, the patient also suffered from progressive dysphagia with body weight loss, chest pain and regurgitation sensation. Therefore, an upper gastrointestinal panendoscopy was performed to exclude the presence of esophageal tumors. A diagnosis of esophageal achalasia was confirmed after an upper gastrointestinal examination series was conducted. After informing the patient, per-oral-endoscopic myotomy was performed. Nutritional supplementation and psychological consultation were also provided. The patient’s symptoms (e.g., chest pain, regurgitation, and dysphagia) improved significantly. Body weight increased from 44 kg to 50 kg, and her anxiety level was gradually reduced. For those who diagnosed with recurrent gastroesophageal reflux disease along with a poor response to oral medications, a detailed inquiry and a specific examination should be conducted for other differential diagnoses, (e.g., achalasia) that may have long-term negative impact on the patient’s nutritional status, sleep disturbance, negative emotions, and quality of life
胸痛为临床常见主述，在排除心因性问题后，常因病人合并胃灼热感，诊断为胃食道逆流。然而本案例为一位36岁女性，因反复进食后胸痛、胃灼热及逆流等症状，依医嘱断续服用氢离子帮浦抑制剂（Proton Pump Inhibitor, PPI）治疗胃食道逆流约一年仍未改善，直至夜间逆流咳嗽加剧，转至本院消化内科求治，问诊后发现合并有吞咽困难及体重减轻情形，安排上消化道内视镜排除食道肿瘤后，经食道摄影检查确诊为食道弛缓不能症（achalasia）。个案接受经口内视镜肌层切开术治疗、营养重建及心理咨商后，胸痛、逆流及吞咽困难等症状大幅改善，体重也从44 kg回复至50 kg，焦虑程度亦渐缓解。针对反复出现与胃食道逆流相似症状，或经药物治疗无效者，应进一步评估有无吞咽困难，与胃食道逆流作鉴别诊断，避免病人因进食困难，造成营养不良并发症，以及长期睡眠困扰导致负向情绪感受，严重影响生活品质。 Chest pain as a relatively common clinical symptom especially when excluding ischemic heart disease, patients are often diagnosed with gastroesophageal reflux disease due to acid regurgitation and a sensation of heartburn. A 36-year-old woman had had been intermittently treated with an oral proton pump inhibitor (PPI) under the impression of gastroesophageal reflux disease for approximately one year due to recurrent chest pain, heartburn, and a sensation of regurgitation. However, the symptoms deteriorated with exacerbation at night, which was an indication of poor response to the oral medication. Thus, she was transferred to the Department of Gastroenterology for further examination and treatment. After detailed inquiry, the patient also suffered from progressive dysphagia with body weight loss, chest pain and regurgitation sensation. Therefore, an upper gastrointestinal panendoscopy was performed to exclude the presence of esophageal tumors. A diagnosis of esophageal achalasia was confirmed after an upper gastrointestinal examination series was conducted. After informing the patient, per-oral-endoscopic myotomy was performed. Nutritional supplementation and psychological consultation were also provided. The patient’s symptoms (e.g., chest pain, regurgitation, and dysphagia) improved significantly. Body weight increased from 44 kg to 50 kg, and her anxiety level was gradually reduced. For those who diagnosed with recurrent gastroesophageal reflux disease along with a poor response to oral medications, a detailed inquiry and a specific examination should be conducted for other differential diagnoses, (e.g., achalasia) that may have long-term negative impact on the patient’s nutritional status, sleep disturbance, negative emotions, and quality of life
{"title":"以胸痛表現之食道弛緩不能症案例報告","authors":"李宥嫻 李宥嫻, 李宗穎 You-Sian Lee, 路子瑩 Chung-Ying Lee, 陳明堯 Tze-Ying Lu, 李佳蓉 Ming-Yao Chen","doi":"10.53106/2410325x2022060901005","DOIUrl":"https://doi.org/10.53106/2410325x2022060901005","url":null,"abstract":"\u0000 胸痛為臨床常見主述，在排除心因性問題後，常因病人合併胃灼熱感，診斷為胃食道逆流。然而本案例為一位36歲女性，因反覆進食後胸痛、胃灼熱及逆流等症狀，依醫囑斷續服用氫離子幫浦抑制劑（Proton Pump Inhibitor, PPI）治療胃食道逆流約一年仍未改善，直至夜間逆流咳嗽加劇，轉至本院消化內科求治，問診後發現合併有吞嚥困難及體重減輕情形，安排上消化道內視鏡排除食道腫瘤後，經食道攝影檢查確診為食道弛緩不能症（achalasia）。個案接受經口內視鏡肌層切開術治療、營養重建及心理諮商後，胸痛、逆流及吞嚥困難等症狀大幅改善，體重也從44 kg回復至50 kg，焦慮程度亦漸緩解。針對反覆出現與胃食道逆流相似症狀，或經藥物治療無效者，應進一步評估有無吞嚥困難，與胃食道逆流作鑑別診斷，避免病人因進食困難，造成營養不良併發症，以及長期睡眠困擾導致負向情緒感受，嚴重影響生活品質。\u0000 Chest pain as a relatively common clinical symptom especially when excluding ischemic heart disease, patients are often diagnosed with gastroesophageal reflux disease due to acid regurgitation and a sensation of heartburn. A 36-year-old woman had had been intermittently treated with an oral proton pump inhibitor (PPI) under the impression of gastroesophageal reflux disease for approximately one year due to recurrent chest pain, heartburn, and a sensation of regurgitation. However, the symptoms deteriorated with exacerbation at night, which was an indication of poor response to the oral medication. Thus, she was transferred to the Department of Gastroenterology for further examination and treatment. After detailed inquiry, the patient also suffered from progressive dysphagia with body weight loss, chest pain and regurgitation sensation. Therefore, an upper gastrointestinal panendoscopy was performed to exclude the presence of esophageal tumors. A diagnosis of esophageal achalasia was confirmed after an upper gastrointestinal examination series was conducted. After informing the patient, per-oral-endoscopic myotomy was performed. Nutritional supplementation and psychological consultation were also provided. The patient’s symptoms (e.g., chest pain, regurgitation, and dysphagia) improved significantly. Body weight increased from 44 kg to 50 kg, and her anxiety level was gradually reduced. For those who diagnosed with recurrent gastroesophageal reflux disease along with a poor response to oral medications, a detailed inquiry and a specific examination should be conducted for other differential diagnoses, (e.g., achalasia) that may have long-term negative impact on the patient’s nutritional status, sleep disturbance, negative emotions, and quality of life\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"39 9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125740866","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}
喘鳴聲是兒童呼吸道的常見症狀，若無正確診斷可能造成呼吸衰竭，甚至生命危險。本案例是一位18個月男童，曾在2次因呼吸衰竭留置氣管內管之插管史，經支氣管擴張劑及類固醇治療後， 仍再次引發喘鳴聲，甚至出現胸骨凹陷，行胸腔電腦斷層發現聲門下狹窄，案童經手術治療後喘鳴聲明顯改善，且出院後3個月內無再發作。因此，當我們遇到氣管內管插管史的兒童，出現喘鳴聲持續72小時以上合併胸骨凹陷，加上對支氣管擴張劑或類固醇等藥物效果不佳時，聲門下狹窄就必須列入考慮。 Stridor is a common symptom of the respiratory system in children that might cause respiratory failure and precipitate life-threatening if not properly diagnosed. An 18-month-old child had 2 times of the endotracheal tube intubation history. After treatment with bronchodilators and steroids, recurrent stridor and sternal depression were discovered. Thoracic computed tomography was performed and revealed subglottic stenosis. After surgical intervention of cricotracheal resection, the child’s stridor was significantly improved and no recurrence within 3 months after discharge. Therefore, children with a history of endotracheal tube intubation, who had stridor more than 72 hours with sternal depression or poor response for bronchodilators and steroids, the possibility of subglottic stenosis should be considered in the differential diagnosis
喘鸣声是儿童呼吸道的常见症状，若无正确诊断可能造成呼吸衰竭，甚至生命危险。本案例是一位18个月男童，曾在2次因呼吸衰竭留置气管内管之插管史，经支气管扩张剂及类固醇治疗后， 仍再次引发喘鸣声，甚至出现胸骨凹陷，行胸腔电脑断层发现声门下狭窄，案童经手术治疗后喘鸣声明显改善，且出院后3个月内无再发作。因此，当我们遇到气管内管插管史的儿童，出现喘鸣声持续72小时以上合并胸骨凹陷，加上对支气管扩张剂或类固醇等药物效果不佳时，声门下狭窄就必须列入考虑。 Stridor is a common symptom of the respiratory system in children that might cause respiratory failure and precipitate life-threatening if not properly diagnosed. An 18-month-old child had 2 times of the endotracheal tube intubation history. After treatment with bronchodilators and steroids, recurrent stridor and sternal depression were discovered. Thoracic computed tomography was performed and revealed subglottic stenosis. After surgical intervention of cricotracheal resection, the child’s stridor was significantly improved and no recurrence within 3 months after discharge. Therefore, children with a history of endotracheal tube intubation, who had stridor more than 72 hours with sternal depression or poor response for bronchodilators and steroids, the possibility of subglottic stenosis should be considered in the differential diagnosis
{"title":"一位18個月男童以反覆性喘鳴聲表現","authors":"陳千琪 陳千琪, 吳淑鈞 Chian-Chi Chen, 黃麗華 Shu-Chun Wu, 周怡伶 Li-Hua Huang","doi":"10.53106/2410325x2022060901009","DOIUrl":"https://doi.org/10.53106/2410325x2022060901009","url":null,"abstract":"\u0000 喘鳴聲是兒童呼吸道的常見症狀，若無正確診斷可能造成呼吸衰竭，甚至生命危險。本案例是一位18個月男童，曾在2次因呼吸衰竭留置氣管內管之插管史，經支氣管擴張劑及類固醇治療後， 仍再次引發喘鳴聲，甚至出現胸骨凹陷，行胸腔電腦斷層發現聲門下狹窄，案童經手術治療後喘鳴聲明顯改善，且出院後3個月內無再發作。因此，當我們遇到氣管內管插管史的兒童，出現喘鳴聲持續72小時以上合併胸骨凹陷，加上對支氣管擴張劑或類固醇等藥物效果不佳時，聲門下狹窄就必須列入考慮。\u0000 Stridor is a common symptom of the respiratory system in children that might cause respiratory failure and precipitate life-threatening if not properly diagnosed. An 18-month-old child had 2 times of the endotracheal tube intubation history. After treatment with bronchodilators and steroids, recurrent stridor and sternal depression were discovered. Thoracic computed tomography was performed and revealed subglottic stenosis. After surgical intervention of cricotracheal resection, the child’s stridor was significantly improved and no recurrence within 3 months after discharge. Therefore, children with a history of endotracheal tube intubation, who had stridor more than 72 hours with sternal depression or poor response for bronchodilators and steroids, the possibility of subglottic stenosis should be considered in the differential diagnosis\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134547966","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 : 2022-06-01DOI: 10.53106/2410325x2022060901002
唐嘉君 唐嘉君, 李達雅 Chia-Chun Tang, 陳盈如 Ta-Ya Lee
專科護理師角色越獨立，越可積極迎接現代社會之健康挑戰，包含醫療資源不均、高齡社會、以及傳染疾病大流行等問題。然而，台灣自專科護理師角色建立以來，各界對其獨立執業之範疇與程度，仍在尋求共識與更好的定位。眼下正值嚴重特殊傳染性肺炎（COVID-19）大流行，原本尚能勉力支撐之醫療資源恐迅速耗竭；如何以最具經濟效益之方法，穩定醫護量能，成為各界專注之焦點。故本文希望藉此契機，援引國際經驗及實證資料，論述專科護理師獨立執業之可能樣貌，及賦能專科護理師可對疫情與其他照護困境產生之正向影響。本文先簡述國內外專科護理師發展背景及執業現況，再從實證資料中分析，各國在COVID-19疫情期間，如何賦予或放寬專科護理師執業權限，進而直接或間接因應疫情衍生之醫療困境。最後，針對本土需求及現況提出建議，盼能藉此文章促進各方對於擴展專科護理師角色之討論及共識。 Higher nurse practitioner practice independence provides more effective solutions to modern health challenges such as health inequalities, aging society, and pandemic, etc. Nevertheless, consensus on nurse practitioners’ scope of practice is still underbuilding in Taiwan. While COVID-19 pandemic has drawn our attention towards cost-effective strategies to avoid system collapse, it is a great opportunity to redefine Taiwan nurse practitioner’s role in the pandemic and health care. Based on empirical evidence, the aim of this opinion paper is to critically describe what nurse practitioner independent practice is and how it can alleviate the burden on health system. We first presented the history and current status regarding nurse practitioners’ scope of practice in Taiwan and in other countries. Then we systematically discussed how governments in other countries temporarily expended or exempted the practice scope of nurse practitioner during the pandemic. We also commented on why nurse practitioners have the potential to solve healthcare resource shortages in difficult situations. Finally, we suggested to expend nurse practitioner’s role in Taiwan and hope to encourage relevant discussions and consensus building.
专科护理师角色越独立，越可积极迎接现代社会之健康挑战，包含医疗资源不均、高龄社会、以及传染疾病大流行等问题。然而，台湾自专科护理师角色建立以来，各界对其独立执业之范畴与程度，仍在寻求共识与更好的定位。眼下正值严重特殊传染性肺炎（COVID-19）大流行，原本尚能勉力支撑之医疗资源恐迅速耗竭；如何以最具经济效益之方法，稳定医护量能，成为各界专注之焦点。故本文希望借此契机，援引国际经验及实证资料，论述专科护理师独立执业之可能样貌，及赋能专科护理师可对疫情与其他照护困境产生之正向影响。本文先简述国内外专科护理师发展背景及执业现况，再从实证资料中分析，各国在COVID-19疫情期间，如何赋予或放宽专科护理师执业权限，进而直接或间接因应疫情衍生之医疗困境。最后，针对本土需求及现况提出建议，盼能借此文章促进各方对于扩展专科护理师角色之讨论及共识。 Higher nurse practitioner practice independence provides more effective solutions to modern health challenges such as health inequalities, aging society, and pandemic, etc. Nevertheless, consensus on nurse practitioners’ scope of practice is still underbuilding in Taiwan. While COVID-19 pandemic has drawn our attention towards cost-effective strategies to avoid system collapse, it is a great opportunity to redefine Taiwan nurse practitioner’s role in the pandemic and health care. Based on empirical evidence, the aim of this opinion paper is to critically describe what nurse practitioner independent practice is and how it can alleviate the burden on health system. We first presented the history and current status regarding nurse practitioners’ scope of practice in Taiwan and in other countries. Then we systematically discussed how governments in other countries temporarily expended or exempted the practice scope of nurse practitioner during the pandemic. We also commented on why nurse practitioners have the potential to solve healthcare resource shortages in difficult situations. Finally, we suggested to expend nurse practitioner’s role in Taiwan and hope to encourage relevant discussions and consensus building.
{"title":"疫情危機下的轉機？新冠肺炎大流行下推動專科護理師獨立作業之契機","authors":"唐嘉君 唐嘉君, 李達雅 Chia-Chun Tang, 陳盈如 Ta-Ya Lee","doi":"10.53106/2410325x2022060901002","DOIUrl":"https://doi.org/10.53106/2410325x2022060901002","url":null,"abstract":"\u0000 專科護理師角色越獨立，越可積極迎接現代社會之健康挑戰，包含醫療資源不均、高齡社會、以及傳染疾病大流行等問題。然而，台灣自專科護理師角色建立以來，各界對其獨立執業之範疇與程度，仍在尋求共識與更好的定位。眼下正值嚴重特殊傳染性肺炎（COVID-19）大流行，原本尚能勉力支撐之醫療資源恐迅速耗竭；如何以最具經濟效益之方法，穩定醫護量能，成為各界專注之焦點。故本文希望藉此契機，援引國際經驗及實證資料，論述專科護理師獨立執業之可能樣貌，及賦能專科護理師可對疫情與其他照護困境產生之正向影響。本文先簡述國內外專科護理師發展背景及執業現況，再從實證資料中分析，各國在COVID-19疫情期間，如何賦予或放寬專科護理師執業權限，進而直接或間接因應疫情衍生之醫療困境。最後，針對本土需求及現況提出建議，盼能藉此文章促進各方對於擴展專科護理師角色之討論及共識。\u0000 Higher nurse practitioner practice independence provides more effective solutions to modern health challenges such as health inequalities, aging society, and pandemic, etc. Nevertheless, consensus on nurse practitioners’ scope of practice is still underbuilding in Taiwan. While COVID-19 pandemic has drawn our attention towards cost-effective strategies to avoid system collapse, it is a great opportunity to redefine Taiwan nurse practitioner’s role in the pandemic and health care. Based on empirical evidence, the aim of this opinion paper is to critically describe what nurse practitioner independent practice is and how it can alleviate the burden on health system. We first presented the history and current status regarding nurse practitioners’ scope of practice in Taiwan and in other countries. Then we systematically discussed how governments in other countries temporarily expended or exempted the practice scope of nurse practitioner during the pandemic. We also commented on why nurse practitioners have the potential to solve healthcare resource shortages in difficult situations. Finally, we suggested to expend nurse practitioner’s role in Taiwan and hope to encourage relevant discussions and consensus building.\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"41 6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129118284","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 : 2022-06-01DOI: 10.53106/2410325x2022060901007
梁郡玲 梁郡玲, 陳正誼 陳正誼
本篇個案是位33歲的年輕男性，因喘及水腫而住院。經抽血檢驗、尿液分析及腎臟超音波檢查， 發現是末期腎臟病患者合併高血壓與嚴重的蛋白尿，須長期接受透析治療。在排除可能的相關鑑別診斷後，經由酵素檢驗、基因分析及腎臟切片檢查，個案確診為法布瑞氏症。本文之目的在強調慢性腎臟病除了常見病因如糖尿病、高血壓及慢性腎絲球腎炎外，若為原因不明的早發性腎臟病變，尤其是發生在年輕男性，須考慮法布瑞氏症的可能性，並及早的接受酵素替代治療，以預防進一步的心臟及腦部病變。此外，也藉由基因篩檢，確診家族中其它法布瑞氏症患者，積極接受早期治療。因此，藉由這篇病例報告，希望醫護人員對法布瑞氏症有進一步的了解，以早期診斷、早期治療，及減少併發症與殘疾的發生。 The 33-years-old young male was hospitalized due to dyspnea and edema. The patient was diagnosed with end-stage renal disease, hypertension and heavy proteinuria requiring long term dialysis treatment. Other possible differential diagnosis were excluded and eventually Fabry disease was confirmed through enzyme assay, genetic analysis and kidney biopsy. The purpose of this study emphasizes on the need to consider the possibility of Fabry disease on young male with unknown reason younger-onset kidney disease in addition to other causes of chronic kidney disease, such as DM, hypertension or chronic glomerulonephritis. Enzyme replacement therapy was administered as soon as possible to prevent pathological development of heart or brain. Furthermore, we also diagnosed other cases of Fabry disease in his family through Genetic Test and early treatments were provided. Therefore, we expected that Fabry disease will not be considered in clinical practice and early diagnosis with treatment could be provided to decrease the complication and disability rates.
本篇个案是位33岁的年轻男性，因喘及水肿而住院。经抽血检验、尿液分析及肾脏超音波检查， 发现是末期肾脏病患者合并高血压与严重的蛋白尿，须长期接受透析治疗。在排除可能的相关鉴别诊断后，经由酵素检验、基因分析及肾脏切片检查，个案确诊为法布瑞氏症。本文之目的在强调慢性肾脏病除了常见病因如糖尿病、高血压及慢性肾丝球肾炎外，若为原因不明的早发性肾脏病变，尤其是发生在年轻男性，须考虑法布瑞氏症的可能性，并及早的接受酵素替代治疗，以预防进一步的心脏及脑部病变。此外，也借由基因筛检，确诊家族中其它法布瑞氏症患者，积极接受早期治疗。因此，借由这篇病例报告，希望医护人员对法布瑞氏症有进一步的了解，以早期诊断、早期治疗，及减少并发症与残疾的发生。 The 33-years-old young male was hospitalized due to dyspnea and edema. The patient was diagnosed with end-stage renal disease, hypertension and heavy proteinuria requiring long term dialysis treatment. Other possible differential diagnosis were excluded and eventually Fabry disease was confirmed through enzyme assay, genetic analysis and kidney biopsy. The purpose of this study emphasizes on the need to consider the possibility of Fabry disease on young male with unknown reason younger-onset kidney disease in addition to other causes of chronic kidney disease, such as DM, hypertension or chronic glomerulonephritis. Enzyme replacement therapy was administered as soon as possible to prevent pathological development of heart or brain. Furthermore, we also diagnosed other cases of Fabry disease in his family through Genetic Test and early treatments were provided. Therefore, we expected that Fabry disease will not be considered in clinical practice and early diagnosis with treatment could be provided to decrease the complication and disability rates.
{"title":"一位33歲年輕男性以末期腎衰竭來表現","authors":"梁郡玲 梁郡玲, 陳正誼 陳正誼","doi":"10.53106/2410325x2022060901007","DOIUrl":"https://doi.org/10.53106/2410325x2022060901007","url":null,"abstract":"\u0000 本篇個案是位33歲的年輕男性，因喘及水腫而住院。經抽血檢驗、尿液分析及腎臟超音波檢查， 發現是末期腎臟病患者合併高血壓與嚴重的蛋白尿，須長期接受透析治療。在排除可能的相關鑑別診斷後，經由酵素檢驗、基因分析及腎臟切片檢查，個案確診為法布瑞氏症。本文之目的在強調慢性腎臟病除了常見病因如糖尿病、高血壓及慢性腎絲球腎炎外，若為原因不明的早發性腎臟病變，尤其是發生在年輕男性，須考慮法布瑞氏症的可能性，並及早的接受酵素替代治療，以預防進一步的心臟及腦部病變。此外，也藉由基因篩檢，確診家族中其它法布瑞氏症患者，積極接受早期治療。因此，藉由這篇病例報告，希望醫護人員對法布瑞氏症有進一步的了解，以早期診斷、早期治療，及減少併發症與殘疾的發生。\u0000 The 33-years-old young male was hospitalized due to dyspnea and edema. The patient was diagnosed with end-stage renal disease, hypertension and heavy proteinuria requiring long term dialysis treatment. Other possible differential diagnosis were excluded and eventually Fabry disease was confirmed through enzyme assay, genetic analysis and kidney biopsy. The purpose of this study emphasizes on the need to consider the possibility of Fabry disease on young male with unknown reason younger-onset kidney disease in addition to other causes of chronic kidney disease, such as DM, hypertension or chronic glomerulonephritis. Enzyme replacement therapy was administered as soon as possible to prevent pathological development of heart or brain. Furthermore, we also diagnosed other cases of Fabry disease in his family through Genetic Test and early treatments were provided. Therefore, we expected that Fabry disease will not be considered in clinical practice and early diagnosis with treatment could be provided to decrease the complication and disability rates.\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115258519","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}
背景：在病人接受冠狀動脈介入治療術後，血腫是拔除橈動脈導管後最常見之合併症，一旦發生也對照護品質造成負面之影響，未改善前血腫發生率高達20.09%。 目的：本專案旨在應用臨床照護指引，來降低病人拔除橈動脈導管後的血腫發生率。 解決方案：參考經橈動脈路徑執行冠狀動脈介入治療的臨床照護指引，擬定解決方法有：（1）定期舉辦冠狀動脈介入治療術後之在職教育；（2）舉辦TR band止血照護的課程與案例討論；（3）制定TR band標準作業流程；（4）制定冠狀動脈介入治療術後照護稽核表與監測制度。 結果：經專案介入後，拔除橈動脈導管後的血腫發生率由20.09%下降至9.3%，不僅達到專案目的，對於護理人員拔除橈動脈導管的認知正確率，也由58.66%提升為96.66%；執行止血照護措施的正確率由57.64%提升至99.21%。 結論：經此專案執行後，不僅降低了拔除橈動脈導管後的血腫發生率，進而也增進了病人在止血過程中的舒適滿意度，結果顯示成效良好，未來將維持此成效以推廣至全院，造福更多心臟病患。 Background: After receiving percutaneous coronary interventions, hematoma is one of the most common vascular complications due to the removal of radial artery. Once happened, there will have a negative impact on the quality of care. The incidence rate of hematoma is up to 20.09% without proper treatment. Purposes: Applying evidence-based clinical care guidelines to effectively assist the medical team to reduce the occurrence rate of hematoma after the removal of radial artery catheter. Methods and Materials: Designing an evidence-based clinical care guidelines based on empirical literature searching and the developed solutions include: regular on-the-job training course, regular TR band hemostasis care course and case study, formulating standard procedures of TR band, formulating a new check list and monitoring system for post-percutaneous coronary intervention. Results and Discussion: After applying the developed guidelines, the occurrence rate of hematoma decreased from 20.09% to 9.3%. As for after-removal of radial artery catheters knowledge, nurses’ cognitive correctness rate increased from 58.66% to 96.66%. The accuracy rate of hemostasis treatment increased from 57.64% to 99.21%. Conclusion: After implementing the project, not only the occurrence of hematoma after removal of radial artery catheter was reduced but also the satisfaction degree about the comfortability was significantly increased. The result indicates that this guideline can be applied in the future to benefit more patients with cardiovascular disease.
背景：在病人接受冠状动脉介入治疗术后，血肿是拔除桡动脉导管后最常见之合并症，一旦发生也对照护品质造成负面之影响，未改善前血肿发生率高达20.09%。目的：本专案旨在应用临床照护指引，来降低病人拔除桡动脉导管后的血肿发生率。解决方案：参考经桡动脉路径执行冠状动脉介入治疗的临床照护指引，拟定解决方法有：（1）定期举办冠状动脉介入治疗术后之在职教育；（2）举办TR band止血照护的课程与案例讨论；（3）制定TR band标准作业流程；（4）制定冠状动脉介入治疗术后照护稽核表与监测制度。结果：经专案介入后，拔除桡动脉导管后的血肿发生率由20.09%下降至9.3%，不仅达到专案目的，对于护理人员拔除桡动脉导管的认知正确率，也由58.66%提升为96.66%；执行止血照护措施的正确率由57.64%提升至99.21%。结论：经此专案执行后，不仅降低了拔除桡动脉导管后的血肿发生率，进而也增进了病人在止血过程中的舒适满意度，结果显示成效良好，未来将维持此成效以推广至全院，造福更多心脏病患。 Background: After receiving percutaneous coronary interventions, hematoma is one of the most common vascular complications due to the removal of radial artery. Once happened, there will have a negative impact on the quality of care. The incidence rate of hematoma is up to 20.09% without proper treatment. Purposes: Applying evidence-based clinical care guidelines to effectively assist the medical team to reduce the occurrence rate of hematoma after the removal of radial artery catheter. Methods and Materials: Designing an evidence-based clinical care guidelines based on empirical literature searching and the developed solutions include: regular on-the-job training course, regular TR band hemostasis care course and case study, formulating standard procedures of TR band, formulating a new check list and monitoring system for post-percutaneous coronary intervention. Results and Discussion: After applying the developed guidelines, the occurrence rate of hematoma decreased from 20.09% to 9.3%. As for after-removal of radial artery catheters knowledge, nurses’ cognitive correctness rate increased from 58.66% to 96.66%. The accuracy rate of hemostasis treatment increased from 57.64% to 99.21%. Conclusion: After implementing the project, not only the occurrence of hematoma after removal of radial artery catheter was reduced but also the satisfaction degree about the comfortability was significantly increased. The result indicates that this guideline can be applied in the future to benefit more patients with cardiovascular disease.
{"title":"降低冠狀動脈介入治療術後拔除橈動脈導管之血腫發生率","authors":"張倚綾 張倚綾, 陳樺萱 I-Ling Chang, 蘇俐菁 Hua-Hsuan Chen, 熊妙玲 Li-Ching Su","doi":"10.53106/2410325x2022060901004","DOIUrl":"https://doi.org/10.53106/2410325x2022060901004","url":null,"abstract":"\u0000 背景：在病人接受冠狀動脈介入治療術後，血腫是拔除橈動脈導管後最常見之合併症，一旦發生也對照護品質造成負面之影響，未改善前血腫發生率高達20.09%。\u0000目的：本專案旨在應用臨床照護指引，來降低病人拔除橈動脈導管後的血腫發生率。\u0000解決方案：參考經橈動脈路徑執行冠狀動脈介入治療的臨床照護指引，擬定解決方法有：（1）定期舉辦冠狀動脈介入治療術後之在職教育；（2）舉辦TR band止血照護的課程與案例討論；（3）制定TR band標準作業流程；（4）制定冠狀動脈介入治療術後照護稽核表與監測制度。\u0000結果：經專案介入後，拔除橈動脈導管後的血腫發生率由20.09%下降至9.3%，不僅達到專案目的，對於護理人員拔除橈動脈導管的認知正確率，也由58.66%提升為96.66%；執行止血照護措施的正確率由57.64%提升至99.21%。\u0000結論：經此專案執行後，不僅降低了拔除橈動脈導管後的血腫發生率，進而也增進了病人在止血過程中的舒適滿意度，結果顯示成效良好，未來將維持此成效以推廣至全院，造福更多心臟病患。\u0000 Background: After receiving percutaneous coronary interventions, hematoma is one of the most common vascular complications due to the removal of radial artery. Once happened, there will have a negative impact on the quality of care. The incidence rate of hematoma is up to 20.09% without proper treatment. \u0000Purposes: Applying evidence-based clinical care guidelines to effectively assist the medical team to reduce the occurrence rate of hematoma after the removal of radial artery catheter. \u0000Methods and Materials: Designing an evidence-based clinical care guidelines based on empirical literature searching and the developed solutions include: regular on-the-job training course, regular TR band hemostasis care course and case study, formulating standard procedures of TR band, formulating a new check list and monitoring system for post-percutaneous coronary intervention. \u0000Results and Discussion: After applying the developed guidelines, the occurrence rate of hematoma decreased from 20.09% to 9.3%. As for after-removal of radial artery catheters knowledge, nurses’ cognitive correctness rate increased from 58.66% to 96.66%. The accuracy rate of hemostasis treatment increased from 57.64% to 99.21%. \u0000Conclusion: After implementing the project, not only the occurrence of hematoma after removal of radial artery catheter was reduced but also the satisfaction degree about the comfortability was significantly increased. The result indicates that this guideline can be applied in the future to benefit more patients with cardiovascular disease.\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"135 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134635573","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}
三環抗憂鬱劑為抗憂鬱用藥之一，在過量時患者可能會出現抗膽鹼症狀、甚至是具有致死風險的中樞神經以及心血管毒性症狀。本篇案例報告介紹一位中年女性因三環抗憂鬱劑中毒而導致意識不清、呼吸衰竭以及癲癇反覆發作，接受緊急氣管內管插管以及鎮靜藥物治療後仍未見改善，但因並未出現典型的抗膽鹼症狀，在十二導程心電圖檢查以及一系列毒藥物篩檢確立診斷後，始接受碳酸氫鈉藥物治療、抗癲癇藥物的控制以及後續血管收縮藥物的支持，其後順利康復。筆者希望藉由此案例分享，以及中毒的臨床症狀、診斷和治療等介紹，能增加臨床同仁對三環抗憂鬱劑中毒的認識，也提醒同仁臨床病人藥物過量時常合併多種藥物使用，使得所謂毒性症候群表現往往不典型，因而增加臨床上診斷的困難度和挑戰性，結合病史詢問、理學檢查以及實驗室檢查仍然是早期診斷藥物中毒的不二法門 Tricyclic antidepressants are a class of antidepressants, an overdose of which may cause anticholinergic syndromes. In severe cases, fatal central nervous system failure and cardiovascular toxicity may occur. This case report describes a middle-aged female patient who was suffered from unconsciousness, respiratory failure, and recurrent seizures due to tricyclic antidepressant toxicity. Emergent endotracheal intubation and sedative drug treatment were failed to improve her condition. Given the absence of typical anticholinergic symptoms, the diagnosis was established followed by a 12-lead electrocardiogram examination and a series of toxic-drug screening. The patient received treatments with sodium bicarbonate, anti-epileptic drugs, and vasopressor support, which led to full recovery from the intoxication. The authors expect that by sharing this case and introducing the clinical symptoms, diagnosis, and treatment of tricyclic antidepressant-induced toxicity, clinicians could be more familiar with this syndromes. We would like to remind our peers that in clinical settings, patients presenting with drug overdose often took several drugs concomitantly. As such, the toxic syndrome is often atypical which increases the difficulty of clinical diagnosis. The combination of medical history inquiry, physical examination, and laboratory tests remains the key for diagnosing drug toxicity at the early stage.
三环抗忧郁剂为抗忧郁用药之一，在过量时患者可能会出现抗胆碱症状、甚至是具有致死风险的中枢神经以及心血管毒性症状。本篇案例报告介绍一位中年女性因三环抗忧郁剂中毒而导致意识不清、呼吸衰竭以及癫痫反复发作，接受紧急气管内管插管以及镇静药物治疗后仍未见改善，但因并未出现典型的抗胆碱症状，在十二导程心电图检查以及一系列毒药物筛检确立诊断后，始接受碳酸氢钠药物治疗、抗癫痫药物的控制以及后续血管收缩药物的支持，其后顺利康复。笔者希望借由此案例分享，以及中毒的临床症状、诊断和治疗等介绍，能增加临床同仁对三环抗忧郁剂中毒的认识，也提醒同仁临床病人药物过量时常合并多种药物使用，使得所谓毒性症候群表现往往不典型，因而增加临床上诊断的困难度和挑战性，结合病史询问、理学检查以及实验室检查仍然是早期诊断药物中毒的不二法门 Tricyclic antidepressants are a class of antidepressants, an overdose of which may cause anticholinergic syndromes. In severe cases, fatal central nervous system failure and cardiovascular toxicity may occur. This case report describes a middle-aged female patient who was suffered from unconsciousness, respiratory failure, and recurrent seizures due to tricyclic antidepressant toxicity. Emergent endotracheal intubation and sedative drug treatment were failed to improve her condition. Given the absence of typical anticholinergic symptoms, the diagnosis was established followed by a 12-lead electrocardiogram examination and a series of toxic-drug screening. The patient received treatments with sodium bicarbonate, anti-epileptic drugs, and vasopressor support, which led to full recovery from the intoxication. The authors expect that by sharing this case and introducing the clinical symptoms, diagnosis, and treatment of tricyclic antidepressant-induced toxicity, clinicians could be more familiar with this syndromes. We would like to remind our peers that in clinical settings, patients presenting with drug overdose often took several drugs concomitantly. As such, the toxic syndrome is often atypical which increases the difficulty of clinical diagnosis. The combination of medical history inquiry, physical examination, and laboratory tests remains the key for diagnosing drug toxicity at the early stage.
{"title":"一位中年女性三環抗憂鬱劑過量後反覆發作癲癇的案例報告","authors":"陳惠祺 陳惠祺, 江偉明 Hui-Chi Chen, 戴逸承 Wai-Ming Kong, 徐英洲 Yi-Cheng Tai","doi":"10.53106/2410325x2022060901008","DOIUrl":"https://doi.org/10.53106/2410325x2022060901008","url":null,"abstract":"\u0000 三環抗憂鬱劑為抗憂鬱用藥之一，在過量時患者可能會出現抗膽鹼症狀、甚至是具有致死風險的中樞神經以及心血管毒性症狀。本篇案例報告介紹一位中年女性因三環抗憂鬱劑中毒而導致意識不清、呼吸衰竭以及癲癇反覆發作，接受緊急氣管內管插管以及鎮靜藥物治療後仍未見改善，但因並未出現典型的抗膽鹼症狀，在十二導程心電圖檢查以及一系列毒藥物篩檢確立診斷後，始接受碳酸氫鈉藥物治療、抗癲癇藥物的控制以及後續血管收縮藥物的支持，其後順利康復。筆者希望藉由此案例分享，以及中毒的臨床症狀、診斷和治療等介紹，能增加臨床同仁對三環抗憂鬱劑中毒的認識，也提醒同仁臨床病人藥物過量時常合併多種藥物使用，使得所謂毒性症候群表現往往不典型，因而增加臨床上診斷的困難度和挑戰性，結合病史詢問、理學檢查以及實驗室檢查仍然是早期診斷藥物中毒的不二法門\u0000 Tricyclic antidepressants are a class of antidepressants, an overdose of which may cause anticholinergic syndromes. In severe cases, fatal central nervous system failure and cardiovascular toxicity may occur. This case report describes a middle-aged female patient who was suffered from unconsciousness, respiratory failure, and recurrent seizures due to tricyclic antidepressant toxicity. Emergent endotracheal intubation and sedative drug treatment were failed to improve her condition. Given the absence of typical anticholinergic symptoms, the diagnosis was established followed by a 12-lead electrocardiogram examination and a series of toxic-drug screening. The patient received treatments with sodium bicarbonate, anti-epileptic drugs, and vasopressor support, which led to full recovery from the intoxication. The authors expect that by sharing this case and introducing the clinical symptoms, diagnosis, and treatment of tricyclic antidepressant-induced toxicity, clinicians could be more familiar with this syndromes. We would like to remind our peers that in clinical settings, patients presenting with drug overdose often took several drugs concomitantly. As such, the toxic syndrome is often atypical which increases the difficulty of clinical diagnosis. The combination of medical history inquiry, physical examination, and laboratory tests remains the key for diagnosing drug toxicity at the early stage.\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129137005","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}
本案例為一名56歲女性因反覆眩暈及耳鳴，經檢查後初步診斷為良性陣發性姿勢性眩暈（Benign Paroxysmal Positional Vertigo, BPPV），接受右耳耳石復位術（Canalith Reposition Procedure），然而，隨著病程進展，接續出現關鍵性的前額眉心處的頭痛及視力模糊的症狀，藉由詳細地病史詢問、身體評估、及相關的檢驗及影像檢查，採用排除及納入相關診斷的鑑別過程，最後確診為蝶鞍空洞症，在詳細地病情解釋後，病人接受經鼻腔內視鏡蝶竇蝶鞍減壓併自體脂肪填充及鼻中隔皮瓣重建手術。不幸地，術後產生腦脊髓液鼻漏的併發症，在及時地重新評估、鑑別診斷及處置，有效的控制併發症避免神經功能惡化，最後病人順利出院，因此引發筆者撰寫動機，期望分享此病例照護經驗，提醒同仁臨床照護病人時需要時刻保持警覺，確保病人回復健康。 The case in this study is a 56-year-old woman who was initially diagnosed with benign paroxysmal postural dizziness because of repeated vertigo and tinnitus after serial examinations. She underwent reduction of otolith of right ear (Canalith Reposition Procedure). However, her symptoms remained and subsequent symptoms of frontal headache and blurred vision occurred. Although symptoms such as vertigo, tinnitus, and headache are common in Meniere’s disease, benign paroxysmal postural vertigo (BPPV), cerebral infarction, etc. eventually we revised the diagnosis to the Empty Sella Syndrome through detailed inquiry of medical history, physical assessment, and image examinations.After well-addressed explanation of the clinical condition, the patient received endoscopic transnasal transsphenoidal approach and packing sella with autologous fat, reconstruction by cartilage and nasal septal flap. Unfortunately, the sequel of cerebrospinal fluid rhinorrhea occurred after the operation. By promptly reassessment, differential diagnosis with proper treatment, the complication was effectively controlled to avoid neurological deterioration, and the patient was discharged without further complication. I sincerely share the experience of this specific case with my colleagues. Keeping vigilant in clinical care of patients to ensure they could return to health.
本案例为一名56岁女性因反复眩晕及耳鸣，经检查后初步诊断为良性阵发性姿势性眩晕（Benign Paroxysmal Positional Vertigo, BPPV），接受右耳耳石复位术（Canalith Reposition Procedure），然而，随著病程进展，接续出现关键性的前额眉心处的头痛及视力模糊的症状，借由详细地病史询问、身体评估、及相关的检验及影像检查，采用排除及纳入相关诊断的鉴别过程，最后确诊为蝶鞍空洞症，在详细地病情解释后，病人接受经鼻腔内视镜蝶窦蝶鞍减压并自体脂肪填充及鼻中隔皮瓣重建手术。不幸地，术后产生脑脊髓液鼻漏的并发症，在及时地重新评估、鉴别诊断及处置，有效的控制并发症避免神经功能恶化，最后病人顺利出院，因此引发笔者撰写动机，期望分享此病例照护经验，提醒同仁临床照护病人时需要时刻保持警觉，确保病人回复健康。 The case in this study is a 56-year-old woman who was initially diagnosed with benign paroxysmal postural dizziness because of repeated vertigo and tinnitus after serial examinations. She underwent reduction of otolith of right ear (Canalith Reposition Procedure). However, her symptoms remained and subsequent symptoms of frontal headache and blurred vision occurred. Although symptoms such as vertigo, tinnitus, and headache are common in Meniere’s disease, benign paroxysmal postural vertigo (BPPV), cerebral infarction, etc. eventually we revised the diagnosis to the Empty Sella Syndrome through detailed inquiry of medical history, physical assessment, and image examinations.After well-addressed explanation of the clinical condition, the patient received endoscopic transnasal transsphenoidal approach and packing sella with autologous fat, reconstruction by cartilage and nasal septal flap. Unfortunately, the sequel of cerebrospinal fluid rhinorrhea occurred after the operation. By promptly reassessment, differential diagnosis with proper treatment, the complication was effectively controlled to avoid neurological deterioration, and the patient was discharged without further complication. I sincerely share the experience of this specific case with my colleagues. Keeping vigilant in clinical care of patients to ensure they could return to health.
{"title":"一位蝶鞍空洞症病人呈現反覆眩暈、耳鳴表現及合併術後鼻漏的照護經驗分享","authors":"張彥清 張彥清, 劉淑芬 Yen-Ching Chang, 許庭綾 Shu-Fen Liu, 湯其暾 Ting-Ling Hsu, 朱大同 Chi-Tun Tang","doi":"10.53106/2410325x2021120802010","DOIUrl":"https://doi.org/10.53106/2410325x2021120802010","url":null,"abstract":"\u0000 本案例為一名56歲女性因反覆眩暈及耳鳴，經檢查後初步診斷為良性陣發性姿勢性眩暈（Benign Paroxysmal Positional Vertigo, BPPV），接受右耳耳石復位術（Canalith Reposition Procedure），然而，隨著病程進展，接續出現關鍵性的前額眉心處的頭痛及視力模糊的症狀，藉由詳細地病史詢問、身體評估、及相關的檢驗及影像檢查，採用排除及納入相關診斷的鑑別過程，最後確診為蝶鞍空洞症，在詳細地病情解釋後，病人接受經鼻腔內視鏡蝶竇蝶鞍減壓併自體脂肪填充及鼻中隔皮瓣重建手術。不幸地，術後產生腦脊髓液鼻漏的併發症，在及時地重新評估、鑑別診斷及處置，有效的控制併發症避免神經功能惡化，最後病人順利出院，因此引發筆者撰寫動機，期望分享此病例照護經驗，提醒同仁臨床照護病人時需要時刻保持警覺，確保病人回復健康。\u0000 The case in this study is a 56-year-old woman who was initially diagnosed with benign paroxysmal postural dizziness because of repeated vertigo and tinnitus after serial examinations. She underwent reduction of otolith of right ear (Canalith Reposition Procedure). However, her symptoms remained and subsequent symptoms of frontal headache and blurred vision occurred. Although symptoms such as vertigo, tinnitus, and headache are common in Meniere’s disease, benign paroxysmal postural vertigo (BPPV), cerebral infarction, etc. eventually we revised the diagnosis to the Empty Sella Syndrome through detailed inquiry of medical history, physical assessment, and image examinations.After well-addressed explanation of the clinical condition, the patient received endoscopic transnasal transsphenoidal approach and packing sella with autologous fat, reconstruction by cartilage and nasal septal flap. Unfortunately, the sequel of cerebrospinal fluid rhinorrhea occurred after the operation. By promptly reassessment, differential diagnosis with proper treatment, the complication was effectively controlled to avoid neurological deterioration, and the patient was discharged without further complication. I sincerely share the experience of this specific case with my colleagues. Keeping vigilant in clinical care of patients to ensure they could return to health.\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122298105","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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