照顧一位接受顯微皮瓣移植手術病人之護理經驗

Nursing Experience of a Patient Received Treatment of Microsurgery of Free Flap Tissue Transfer

林文淑(Wen-Shu Lin) ； 龔文娟(Wan-Chuan Kung)

《馬偕護理雜誌》 8卷2期 (2014/07) Pp. 51-60

https://doi.org/10.29415/JMKN.201407_8(2).0005

摘要

本文是探討一位年輕患者，因車禍導致右腳接受顯微皮瓣移植手術之護理經驗。護理期間為西元2011年3月20日至2011年4月2日運用Gordon十一項評估，藉由觀察、會談及傾聽技巧，與個案建立良好的護病關係，讓個案表達其感受，在評估後發現個案有急性疼痛、周邊組織灌流失效、潛在危險性廢用症候群及焦慮等護理問題。護理過程中，運用一對一會談技巧，提供顯微皮瓣移植手術後護理資訊與指導，使個案能渡過顯微術後觀察期間不確定感，同時也提升對顯微手術的了解及相關照護能力，讓個案身體發揮最大功能，並在護理人員的引導及陪伴下，介紹成功個案與其會談，個案能從他人經驗減輕焦慮，增強信心，並以醫院焦慮憂鬱量表評估顯示其焦慮狀態。臨床上發現，外科病房護理人員皆了解病人接受顯微手術會產生焦慮，但因種種限制，未深入評估及積極介入護理措施，希望藉由此次的護理經驗，可提供外科病房護理人員照護此類似個案之參考，正視個案焦慮的問題，給予持續性的關懷照護，以提升臨床之照護品質。

關鍵字

顯微手術 ； 焦慮 ； 疼痛

並列摘要

This study reports a nursing experience of taking care of a young patient who had a car accident and received microsurgery of free flap tissue transfer on his right foot. The nursing process has been taking place from 2011 March 20th to April 2nd. The Gordon's 11 Functional Health Patterns has been used as a guide to observe, communicate and listening to the patient. Once patient and nurse reach a fine relationship then patient could express how he feels. After evaluate the patient, author has discovered that patient was suffered from pain, loss of arterial supply of the wound, risk of disuse syndrome and feeling anxiety. During the nursing process, surgery nurse had provided their caring and listening to build a fine relationship between nurse and the patient. The nursing team had used one on one technique, and systematically offered nursing instructions of post-microsurgery treatment to help patient to get through the uncertainty of the post-operation situation. Help him make a great work out of his body and let him feel control of his body. After talking to some successful cases, the patient was relieved the anguish and enhanced the courage. According to the assessment of Hospital Anxiety and Depression Scale, author noticed that anxiety score was developed from 9 to 3 and depress score from 8 to 3. Hoping that by providing this study nursing experience, we can use it as a reference of the similar cases. And to take seriously about patient's anxiety, provide a consistence caring in order to enhance the quality of nursing care.

並列關鍵字

microsurgery ； anxiety ； pain