一位頸椎損傷加護病房患者之護理經驗

A Nursing Experience of an ICU Patient with Cervical Spinal Injury

史意絹(Yi-Chuan Shih) ； 伍碧琦(Pi-Chi Wu)

《新臺北護理期刊》 17卷1期 (2015/03) Pp. 67-76

https://doi.org/10.6540/NTJN.2015.1.007

摘要

本文描述一位車禍導致第五、六頸椎損傷術後男性患者之加護經驗。筆者於2012年6月26日至7月13日期間，運用Gordon十一項健康評估工具，透過身體評估、觀察、直接護理、筆談及病歷查閱進行評估，確立有呼吸道清除功能失效、急性疼痛、床上活動功能障礙及焦慮等健康問題。優先運用疼痛緩解技巧降低術後疼痛與減輕生理不適，透過主動關懷、陪伴與家屬支持，強化身體功能與復健建構護病關係，協助其對疾病的瞭解，鼓勵表達需求與內心感受，並給予正向肯定及支持，增進非語言溝通的能力減低焦慮，進而改善生活品質來提升自信，讓其有勇氣面對損傷後的改變。藉此經驗分享面對頸椎損傷術後患者，除了滿足疾病造成的生理不適，更需重視其心理調適的歷程。

關鍵字

頸椎損傷 ； 疼痛 ； 身體活動功能障礙 ； 焦慮

並列摘要

This paper describes the nursing experience of a 67-year-old male ICU patient with cervical spinal injury. Information was collected via physical examination, observation, direct nursing, written communication, and chart review from June 26, 2012 to July 13, 2012. Gordon 11 Function Health Patterns for complete evaluation was used. Problems identified included ineffective airway clearance, acute pain, impaired physical mobility, and anxiety. Priority is placed on pain relief of postoperative wound pain, followed by reducing physical discomfort caused by the condition. Through active care and companionship, in conjunction with family support, rehabilitation of physical function can establish a better nurse-patient relationship. Patients are encouraged to express their needs and feelings and to enhance their ability to communicate non-verbally to assist with an understanding and awareness of the condition. Nurses are encouraged to give positive recognition and support to the patients to reduce their anxiety, thereby enhancing self-confidence and providing the courage to face changes after the injury and improving the patients' quality of life. This paper can provide experience in caring for patients after cervical spinal injuries, not only relieving physical discomfort caused by the condition, but also focusing on the patients' psychological adjustment.

並列關鍵字

Cervical spinal injury ； Pain ； Impaired physical mobility ； Anxiety

參考文獻

Beeckman, D., Schoonhoven, L., Verhaeghe, S., Heyneman, A., & Defloor, T. (2009). Prevention and treatment of incontinence- associated dermatitis: Literature review. Journal of Advanced Nursing, 65(6), 1141-1154. doi: 10.1111/j.1365-2648.2009.04986.x

Branco, B, C., Plurad, D., Green, D. J, Inaba, K., Lam, L., Cestero, R., ...& Demetriades, D. (2011). Incidence and clinical predictors for tracheostomy after cervical spinal cord injury: A national trauma databank review. The Journal of Trauma, 70(1), 111-115. doi: 10.1097/TA.0b013e3181d9a559

行政院衛生署（2012年，05月25日）‧100年國人主要死因統計 ‧取自 http://www.doh.gov.tw/CHT2006/DM/DM2_p01.aspx?class_no=25&2006level_no=1&doc_no=84788

何惠玲、李美雲（2010）‧運用賦權概念協助一位脊髓損傷個案適應疾病之護理過程‧安泰醫護雜誌，16（1），29-40。

吳佩玲、何學厚（2011）‧一位頸部脊椎神經損傷患者之護理經驗‧中山醫學雜誌，23（1），45-54。