一位不完全脊髓損傷病人之急診照護經驗

An Emergency Nursing Experience of a Patient with Incomplete Spinal Cord Injury

蔡維倫(Wei-Lum Tsai) ； 郭嘉琪(Chia-Chi Kuo)

《長庚護理》 28卷2期 (2017/06) Pp. 303-313

https://doi.org/10.3966/102673012017062802010

摘要

本文旨在探討一位60歲女性因外傷導致腰椎骨折合併不完全脊髓損傷的急診護理經驗。護理期間自2014年6月19日10：30至16：44，運用Gordon十一項健康功能型態為評估架構，藉由身體評估、觀察、會談、病歷查閱等方式資料收集，確立急診期間的健康問題為急性疼痛、身體活動功能障礙及焦慮。個案因高處跌落意外造成嚴重脊髓損傷，致肢體疼痛、活動功能障礙及對手術與預後的焦慮，因而在急診發洩負向情緒影響急性期照護與手術決策。急診團隊運用放鬆技巧、圓滾木翻身與舒適擺位，來減輕疼痛與預防身體活動功能障礙的續發性傷害，運用傾聽、關懷及口頭鼓勵方式，引導個案說出焦慮感受，再透過問題釐清與心理支持，讓個案有信心接受手術與面對未來挑戰，幫助提升治療配合度與早期治療成效。

關鍵字

脊髓損傷 ； 急性疼痛 ； 身體活動功能障礙 ； 焦慮

並列摘要

This paper describes the emergency nursing experience of caring for a 60-year-old female patient with traumatic lumber fracture combined with incomplete spinal cord injury. The nursing period was from 10:30 to 16:44 on June 19, 2014. We used Gordon's 11 functional health patterns as the assessment framework and collected data through physical assessment, conversations, and chart review. The health problems included acute pain, physical activity dysfunction, and anxiety. Due to severe spinal cord injury caused by an accidental fall from height, this patient experienced extremity pain, physical activity dysfunction, and anxiety toward surgery and prognosis. The patient vented negative emotions at the emergency department, which adversely affected the emergency nursing care and surgical decision-making. During the nursing process, the emergency team conducted strategies such as relaxation techniques, logrolling, and positioning to alleviate the patient's pain and prevent secondary injury from physical activity dysfunction. In addition, we applied listening, caring, and verbal encouragement to guide the patient to express anxiety. We also provided problem clarification and mental support to convince the patient to undergo surgery and face future challenges, and improve the treatment adherence and outcomes of early intervention.

並列關鍵字

spinal cord injury ； acute pain ； physical activity dysfunction ； anxiety

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衛生福利部(2017，6 月)．105 年主要死因統計結果分析．取自http://dep.mohw.gov.tw/DOS/cp-3352-33576-113.html[Ministry of theHealth and Welfare (2017, June). Analysis of the major causes of death, 2016, Taiwan. Retrieved from http://dep.mohw. gov.tw/DOS/cp-3352-33576-113.html]