照顧一位多發性內生軟骨瘤骨折學齡期個案之手術全期護理

Perioperative Nursing Care Experience of a School-Aged Child with Enchondromatosis-Related Fracture

張雅娟(Ya-Chuang Chang) ； 袁秋榮(Ciou-Rong Yuan) ； 戴宏達(Hung-Da Dai)

《榮總護理》 33卷4期 (2016/12) Pp. 364-371

https://doi.org/10.6142/VGHN.33.4.364

摘要

多發性內生軟骨瘤屬於罕見非遺傳性良性腫瘤，容易造成肢體扭曲、變形、變短而產生病理性骨折，臨床上多以刮除術、異體骨或自體骨碎骨填充治療。本文旨在探討一位學齡期女童罹患多發性內生軟骨瘤因意外導致右股骨幹病理性骨折而行骨瘤刮除及內固定植骨術之全期護理。筆者自2014 年7 月20 至25 日照護期間，藉由觀察、會談、查閱病歷資料及身體評估等方式收集資料，運用Gordon 十一項健康功能型態評估工具，確立個案有「焦慮」、「高危險性傷害」、「疼痛」及案父母有「照顧者角色緊張」等健康問題。筆者以手術室全期護理師角色，於術前探視個案了解造成心中疑慮之癥結，並使用視覺圖像讓學童了解手術過程以減緩緊張情緒；術中提供醫護團隊專業照護，維護手術安全預防高危險性傷害；術後根據個案狀況給予傷口照護及復健之相關護理指導，協助順利出院，並協助與案父母一同面對後續的疾病照顧。期盼藉此護理經驗提供日後照顧類似個案之參考。

關鍵字

多發性內生軟骨瘤 ； 手術全期護理 ； 照顧者角色緊張

並列摘要

This article describes a school-age child with enchondromatosis, who had experienced pathologic fracture over the right femur shaft and had received perioperative nursing for the curettage of tumor, bone graft and internal fixation surgery. Using Gordon's model, we identified that the patient exhibited complications such as pain, anxiety, and potential risk of injury; we also observed caregiver role strain in caretaker during July 20-25, 2014. After serving as an attending nurse in an operating department, the author was motivated to write this article as an attempt to decrease the amount of stress experienced by patient and her family by understanding their preoperation anxieties as well as to provide professional medical care during the operation and treatment and rehabilitation instruction after the operation. We hope that the experience presented in this article can serve as a reference for similar cases in the future.

並列關鍵字

Enchondromatosis ； perioperative nursing ； caregiver role strain

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