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時光飛逝 10371 2014-09-16 06:51:32
希望時間能回到剛入學的時候
現在三年級讀完了，邁向四年級了
真的過好快好快😢😢
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我所認識的八大核心素養 4671 2014-09-15 22:49:39
當第一年學期開始時我總以為護理像是條簡單的路程,哪怕是耳裡聽了許多關於護理的事情,可是對於那些話心不以為然,但當真正接觸到專業科目時才發現其實錯了還錯的離譜,當時也是自己心甘情願的選擇,那既然走了就繼續下去吧.對於護理我一直覺得是一件我還無法能確定自己真正能有自信的當上護理師,畢竟這是需要物起責任的職業,這是面對生命而不是兒戲.在職場上它是需要技能而不像我們小時候所謂的扮家家酒,那面對的是生老病死,可能會因自己的疏忽喪失了他人的未來,更葬送了自己的護理之路,人家說只要是金錢能解決的都會是小事,因為比起金錢,生命更是無價.技能只要有心人人都能學會,但是要學得更紮實飽滿,不管未來會不會用上,但這些都是我們需要學習,畢竟職場上是需要技能的.我們也須學習如何觀看檢驗結果,因為我們可能就是藉由這些結果直接發現個案的病情,使我們無須耽誤個案治療時間,更減少個案的病痛.在護理當中我們需要學習如何正確的批判思考,因為並非書上說的我們能一字不漏的記著,那我們就需要利用那些正確的批判性使個案能減緩病痛,批判性大概就是我需要學習最多的地方了,畢竟這也可說是需要經驗及歷練漸漸累積而成的,或許現在的醫學科技越來越發達,但醫療類並不是仰賴科技就能解決的.我們也需要學習了解如何降輕個案的痛苦,並不每位個案都只是器官上的疼痛,或許心靈往往大於這些因素,身心靈才會是真正的建康,所以我們需要以同理心關愛每位個案,就像癌症,它或許又能稱為絕症,但並不是每人因此而放棄希望,或許就因為一句話使個案能堅強的走過這些病痛,因為正面的思想可能會讓個案離死亡又遠了一步.當然也是需要與個案透過溝通和同儕間的合作使每位個案能放心的交予給我們,同時也是考驗我們的耐心,雖然心中有再多的不悅,也必須忍氣吞身,畢竟個案們是承受者痛苦.在護理之中個案的個資及隱私是需要我們尊重的,並不是每位個案都能敞開心胸任人擺布,其實那心理也很不舒服,更別說受到汙辱,那更會造成個案的更大創傷,而且也可能會因此毀了自己的未來.護理的職責是一旦扛上就不得鬆懈的,我們手裡握的是生命,或許我們沒有醫師的偉大以及知識,但我們也需要為個案負責護理二字,因為我們或許就是照護的關鍵.當醫學是永遠在進步,所以我們更不是活在書籍裡面也需要實際的經驗及知識,並不是因為這五年的學習就能負責起我們往後護理能力,我們必須不斷的學習不斷的成長,使我們在護理界闖出自己的一片天.其實到後來都知道護理不好走尤其在現代缺少醫師護理師的時代,生怕未來台灣會開放大陸的護理師,那這下真怕會丟了護理,畢竟對岸學習的或許比我們更紮實,我知道台灣的醫學科技在現在是很厲害但也因此人力更缺乏,即使每個國家都在人資缺乏,但護理並不是人人能走長遠,內幕有太多太多不是人人能接受的.護理很累,但真希望自己能繼續持續下去.
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暑假作業─三篇個案報告心得 4671 2014-09-15 22:45:22
我閱讀完這些個案報告之後覺得照顧好自己的身體真的非常重要！尤其是現在的人非常愛喝飲料，對於身體的各個器官是有害的；其中影響最重的應該是腎臟。透過以下的個案報告我們會知道「洗腎」的內容，以及了解「洗腎」對我們人體會有什麼樣的影響，並且還會知道「洗腎」患者的心理壓力。在「照護一位末期腎疾病患者面對血液透析治療之護理經驗」中有提到，「洗腎」就是「血液透析」，是用來清除肌酸酐、尿素氮……等等的廢物，並且含有排除水分、調節體內電解質的功能；但是「血液透析」也有很多的副作用，像是頭暈、心悸、噁心嘔吐、肌肉抽搐……等等的問題。這篇個案報告的患者因為頭暈以及食慾差加上體重減輕許多所以到醫院檢查，發現患者的尿毒指數偏高需要做「血液透析」。患者一開始不肯配合，後來才答應用「血液透析」來治療。患者的護理問題有營養少於身體的所需，是因為尿毒症所引起的一些症狀，像是食欲差以及噁心感。護理人員所採取的護理措施為選擇合適的食物來改善個案的食慾，並且告知個案定期的「血液透析」能夠改善噁心感，以及改善口腔尿毒症味會減輕。患者另外一個護理問題是知識的缺失，這時就要衛教個案，讓個案知道「血液透析」的內容，並且要詳細的說明會有什麼樣的副作用出現，讓個案了解狀況。下一篇個案報告是「照顧一位首次接受血液透析患者之護理經驗」。在這篇個案報告裡有提到說此篇的個案因為有呼吸喘、下肢水腫、食慾不振以及噁心嘔吐的症狀而入院檢查，檢查之後結果為「急性肺水腫」，需要執行「血液透析」的治療。患者的護理問題為體液容積過量，患者因為常常覺得口渴一直想喝水，所以每天都會買飲料，這時候的護理措施為「限鈉飲食」，並且要增加水份的攝取；還有當患者口渴的時候能用棉花棒沾濕嘴唇，以改善患者口渴的狀態。患者的護理問題還有心理調適障礙，個案覺得「洗腎」會讓身體很不舒服，還要常常跑醫院覺得很疲累；並且覺得有很多的事情現在都需要請家裡的人幫忙，覺得這樣會增加家人的負擔；這時的護理措施就是傾聽個案的想法，並且鼓勵個案，和個案有良好的溝通。最後一篇的個案報告是「照顧一位長期血液透析患者心理社會問題之護理經驗」這篇個案報告的患者有慢性疼痛的問題，這時候的護理措施為給予止痛的藥劑，並且讓個案執行深呼吸、冥想……等等的方式來轉移注意力，以達到緩解疼痛的效果。患者除了有疼痛的護理問題之外還有疲憊以及無望感的護理問題，這時候我們要多給予患者關心並且盡力的協助他們，讓他們能夠減輕心理的壓力。所以這些個案報告讓我們知道說平常的身體保養真的很重要！日常生活要規律並且要多喝水少喝飲料，讓自己的體內排掉多餘的廢物，像是文獻內容所提到的多餘的肌酸酐……等等，讓自己的身體隨時都維持在最佳的狀態！
文章資料出處：
馬麗卿、謝湘俐(2008)‧照護一位末期腎疾病患者面對血液透析治療之護理經
驗‧臺灣腎臟護理學會雜誌，7(1)，60-73。
張翠芬、蔡月英、劉家妤、劉怡萍(2014)‧照顧一位首次接受血液透析患者之護
理經驗‧領導護理，15(1)，61-70。
吳淑榕、蘇淑惠(2007)‧照顧一位長期血液透析患者心理社會問題之護理經驗‧
澄清醫護管理雜誌，3(2)，58-64。
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暑假華藝文章9-水飛薊賓對T細胞免疫反應之調節作用 11229 2014-09-15 19:23:33
文章名稱:水飛薊賓對T細胞免疫反應之調節作用 The modulatory effect of silibinin on T cell immune responses
作者名稱:郭馥華 , 碩士 指導教授：詹東榮
資料來源:無
內容摘要: 水飛蓟賓 (silibinin) 和水飛蓟 (silymarin) 用於治療肝臟疾病已經有相當久的歷史 (Gazak
at al, 2007)，近年來，更廣泛作為保健食品或是醫療用途的藥品製劑，包含臺灣 。截至目前為止，
科學文獻的研究報告證實水飛蓟賓和水飛蓟具有許多有潛力的生物活性作用，其中包含對免疫的
調節作用，例如影響 T 細胞的功能及其細胞激素基因的表現。然而，有關水飛蓟賓和水飛蓟對
Th1/Th2免疫平衡的影響，現有的文獻報告之結果並不ㄧ致，仍有待進一步釐清。因此，本論文
的主旨在研究水飛蓟賓對Th1/Th2 免疫反應的作用，採用包含離體細胞培養和活體動物模式，探
討水飛蓟賓對 T 細胞參與的抗體生成、呼吸道過敏性免疫反應和細胞激素基因表現的影響。實
驗結果顯示，在卵白蛋白(ovalbumin；OVA)免疫的 BALB/c 小鼠，於免疫前連續三天口服投予
水飛蓟賓，具有促進脾臟細胞表現 IFN-γ和血清中OVA 專一性IgG2a 抗體生成的作用；而且，脾
臟細胞表現IL-4 和血清中OVA 專一性抗體IgE及total IgE 則受到水飛蓟賓的抑制。這些證據顯
示口服水飛蓟賓會使OVA 免疫小鼠的 T 細胞免疫反應，傾向Th1 的方向。本論文進一步採用以
OVA氣霧刺激OVA 免疫小鼠之呼吸道過敏的動物模式，結果發現在免疫前以及氣霧刺激前口服
投予水飛蓟賓，對呼吸道所引起的過敏性發炎反應沒有影響，但有促進肺臟組織中IFN-γ mRNA
表現的效果。在離體細胞培養的實驗模式，以水飛蓟賓處理由 OVA 免疫小鼠分離的脾臟細胞，
發現對 IFN-γ和 IL-4 皆有抑制作用，這些結果顯示在離體細胞直接暴露於水飛蓟賓的實驗條件
下，水飛蓟賓對於脾臟細胞表現細胞激素基因的作用和活體給藥的結果不同。 本論文採用BALB/c
鼠，嘗試了二種動物模式活體投予水飛蓟賓，和一種離體細胞模式處理水飛蓟賓，所得實驗結果
仍然欠缺一致的結論，分析水飛蓟賓在現有文獻報告中，對 Th1/Th2 的影響亦有許多分歧的實驗
證據，顯示水飛蓟賓對 T 細胞免疫反應作用之複雜，仍有待進一步加以釐清。值得一提的是，
在本論文的離體試驗模式下，水飛蓟賓在較低的濃度(5-10 μM)下，即對Th1 (IFN-γ)和Th2 (IL-4)
細胞激素有明顯的影響，合併活體給藥的實驗結果，明顯指出 T 細胞是水飛蓟賓的作用標的之
一，其影響細胞激素基因表現的機轉值得未來加以深入探討。
Silibinin and silymarin have been used as herbal medicines to treat liver disease for a long time.
Recent years, silibinin and silymarin has been commonly used as dietary supplements, as well as
medicinal products in many countries, including Taiwan. To date, scientific evidence indicates that
silibinin and silymarin possess potential biological activities, including immune modulation (i.e. effects
on T cell reactivity and cytokine expression). Although the immunomodulatory activity of silibinin on
T cell functionality has been documented, contrasting effects on the balance of T helper (Th)1/Th2
cell-mediated immunity were reported. Hence, the objective of the present study was to investigate the
effect of silibinin on Th1/Th2 immune balance. Both animal models and cell culture experiments were
employed to examine the influence of silibinin on T-dependent antibody production, T cell-mediated
allergic airway responses, and cytokine expression. The results demonstrated that daily oral
administration of silibinin for 3 days prior to ovalbumin (OVA) sensitization markedly enhanced the
production of IFN-γ
by splenocytes and the serum level of OVA-specific IgG2a in OVA-sensitized
BALB/c mice. In contrast, the production of IL-4 and OVA-specific IgE and total IgE was attenuated.
These finding indicates that silibinin administration polarizes the Th1/Th2 balance toward the Th1
direction. In the murine model of allergic airway responses induced by the challenge of OVA aerosol to
OVA-sensitized mice, no significant effect on the airway allergic immune response by silibinin
administration was observed; however, the steady state mRNA expression of IFN-γ in the lung tissues
of OVA-sensitized and challenged mice was markedly enhanced by silibinin administration.
Furthermore, the direct effect of silibinin on T cell-derived cytokine expression was also studied in
vitro. Splenocytes obtained from OVA-sensitized mice were exposed to silibinin in culture and
stimulated with OVA to induce cytokine production. The results showed that silibinin exposure
significantly attenuated the production of both IFN-γ and IL-4 by OVA-stimulated splenocytes. These
results demonstrated that the effects of silibinin on T cell cytokine expression between the employed in
vivo and in vitro experimental settings are inconsistent. The present study utilized 3 experimental
systems, including animal models and cell culture experiments, to examine the immunomodulatory
effect of silibinin on T cells; however, the results on T cell cytokine expression are contrasting. The
inconsistency of silibinin-mediated effects on the Th1/Th2 immune balance has been reported in the
literature, suggesting a very complicated profile of silibinin influence on the immune system. It is
noticed that, under the employed condition of cell culture studies, the effective concentration range of
IV
silibinin (5-10 μM) to affect Th1 (IFN-γ) and Th2 (IL-4) cytokine expression is lower than the
concentrations used by many reports in the literature. Together with the demonstrated effects of
silibinin on Th1/Th2 cytokine expression in murine models, it is apparent that T cells are a sensitive
target for silibinin. Further studies to elucidate the mechanism of silibinin-mediated effects on cytokine
expression are warranted.
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暑假華藝文章4-以大鼠模式探討帕金森症患者睡眠失常之機轉 11229 2014-09-15 19:20:32
文章名稱:以大鼠模式探討帕金森症患者睡眠失常之機轉 The sleep Disturbance in Rats with Parkinsonism
作者名稱:呂瑾瑜 , 碩士 指導教授：張芳嘉
資料來源:無
內容摘要:帕金森氏症 (Parkinson’s Disease, PD) 於1817年由英國的帕金森醫師發表的病例報告之後，世人開始注意到這些患者。在許多人投入帕金森的研究之後，針對帕金森症患者的大腦進行種種實驗，發現患者腦中紋狀體 (striatum) 的多巴胺含量顯著少於正常人，進一步分析則發現，多巴胺減少是由於患者黑質 (substantia nigra, SN) 所存活分泌多巴胺的神經元大量減少，並由此結果得知帕金森患者所出現的眾多症狀皆起因於此。
本研究關心的重點在帕金森患者所產生的睡眠症狀上，這個部分較不為一般人所重視，有許多症狀產生的機轉仍待研究人員進一步了解。我們試著將藥物直接施打於大鼠大腦黑質處，阻斷黑質附近ubiquitin-proteasome system之功能，造成被ubiquitin結合的蛋白質無法經由proteasome分解而大量堆積於位在黑質的多巴胺神經元，而使微膠細胞 (microglia cell) 活化，造成多巴胺神經活性衰退，大鼠上產生類似PD患者的睡眠障礙症狀，並藉由此模式來探討PD患者睡眠產生改變的機轉是否經過微膠細胞活化所釋放之細胞素 (cytoki...
For patients with the Parkinson’s disease (PD), the degeneration of dopaminergic neurons causes the decrease of dopamine release from the substantia nigra pars compecta (SNpc) to the striatum. It is also found that the PD patient’s brain has inclusion bodies of α-synuclein in this area. These inclusion bodies can lead to activate mitochondrial and to subsequently release cytokines, such as tumor necrosis factor – alpha (TNF-α) and interlukin-1beta (IL-1β), which affect the PD patient’s sleep. We herein used a proteasome inhibitor, MG-132, to inhibit the function of proteasome, which caused the loss of dopaminergic neurons in SNpc, and subsequently changed the sleep architecture in rats. The total amount of NREMS was significantly increased, and the of wakefulness was decreased during the dark-period at the 7th day after MG-132 treatment. We administered tumor necrosis factor receptor fragment (TNFRF) and interlukin-1 receptor antagonist (IL-1ra), to elucidate the involvement of TNF-α and IL-1β in MG-132-induced sleep alteration. The MG-132-induced sleep alteration was reversed after...
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