一位年輕女子下顎骨骨折之手術全期護理經驗

An Experience of Perioperative Nursing for a Young Female Patient Who Underwent Mandibular Fracture

蔡佳玲(Chia-Line Tsai) ； 謝春金(Chun-Chin Hsieh)

《長庚護理》 28卷3期 (2017/09) Pp. 519-527

https://doi.org/10.3966/102673012017092803012

摘要

本文個案正值青春期，因車禍導致下顎骨折，短時間面對手術治療及未知的預後，承受極大的壓力，造成焦慮且擔心日後是否影響外觀，因此引發收案動機。照護期間自2015 年4 月27 日至5 月1 日，藉由觀察、會談、身體評估及病歷查閱等方式收集資料，針對個案之生理、心理、社會及靈性層面進行整體性評估，確立個案有焦慮、潛在危險性皮膚完整性受損及身體心像改變之健康問題。照護過程中運用術前訪視的陪伴與個案及家屬建立良好的護病關係，評估個案需求，並擬定個別性護理計畫，以手術相關資訊增進其信心並降低焦慮；於手術全程密切監控，避免手術傷害之發生；幫助個案增強自我信心，協助個案進行正向調適，重返人群與回歸原來的生活。針對青春期個案建議強調青少女的個人特質與優點，讓青少女認同自己仍擁有許多的能力且是有用的，得以重新看待自己及生命意義。希望藉此護理經驗提供照護此類病人之參考。

關鍵字

下顎骨骨折 ； 手術全期護理 ； 身體心像改變

並列摘要

This article presents the experience of perioperative nursing for a young female patient who underwent mandibular fracture treatment. The patient was in puberty and was suffering from mandibular fracture caused by a car accident. In a short period of time, she had to undergo surgery and the prognosis was unforeseen, which put her under a lot of pressure. The nursing period was from April 27th to 30th, 2015. Through direct care, observation, and interview to collect data, we evaluated this patient comprehensively and concluded this patient had problems of anxiety, risk for impaired skin integrity, and body image change. In the preoperative phase, the author visited and accompanied the patient and thus built a good nurse-patient relationship with the patient and patient's family. Individual nursing program was then designed based on the patient's needs. Surgical information was also shared with the patient to build her confidence and lower her anxiety. During the intraoperative phase, the process was closely monitored to avoid any potential injury. Finally, in the postoperative phase, measures were done to help the patient build self-confidence and undergo positive adjustment in order for her to leave the shadows of the car accident behind and get back to her normal life. The article hopes that this nursing experience can be of use to operating room staff when nursing patients with similar situation.

並列關鍵字

mandibular fracture ； peri-operative nursing ； body image change

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