照護一位車禍多重骨折術後病人之護理經驗

Nursing Experience of Multiple Fractures with Traffic Accident in a Post Surgery Patient

林鈺嫺(Chia-Ling Hsu) ； 蘇家（糹柔）(Jia-Rou Su) ； 胡瑞桃(Shui-Tao Hu)

《長庚護理》 29卷2期 (2018/06) Pp. 282-293

https://doi.org/10.6386/CGN.201806_29(2).0011

摘要

本篇報告主要探討一位19歲女性，因酒後機車車禍四肢開放性骨折，於2015年7月1日緊急進行雙側股骨切開復位外固定及霍夫曼固定術，7月4日至8月12日於骨科病房照護期間，個案及家屬面對突發的意外，極度擔心疾病進展及預後等相關問題，引發撰寫此報告之動機。期間運用傾聽、會談、角色參與及身體評估等資料收集，採用Gordon功能性健康型態十一項進行評估，個案依序有急性疼痛、身體活動功能障礙及焦慮等健康問題。醫療團隊積極提供個別性照護措施，包括指導個案術後疼痛控制方法、協助肢體活動擺位、協助增進身體舒適度、安排醫師告知病情進展和術後復健進度等相關照護措施。個案於照護期間，疼痛改善、於家屬陪同下積極參與復建治療、對病情進展的瞭解降低焦慮，最後個案病情穩定於8月12日轉至復健科繼續治療，8月25日順利出院。經由個案同意出院後電訪得知，個案出院後可獨立執行相關日常生活，一個月後返回最愛的咖啡廳吧檯就業。建議照護多重性骨折病人時，術後透過跨團隊會議，與個案/家屬共同擬訂術後復健及出院照護計畫，同時以復健照護日程表呈現，住院期間個案/家屬依日程表參與復健，並依個案復健進展調整復健進度，於出院前再進行評估追蹤個案完成復健狀況及衛教指導改善，以利個案出院後能自我照顧。希望藉此經驗分享，提供日後臨床照護之參考。

關鍵字

多重性骨折 ； 車禍 ； 術後病人

並列摘要

The report described the nursing experience of caring a 19-year-old girl with multiple open fractures on limbs due to a drunk-riding motorcycle accident. The patient received bilateral femoral open external reduction and Hoffman fixation on July 1, 2015. The patient and her families faced the unexpected accident, expressing extreme worry about the progression and prognosis of the injury. The nursing period was from July 4 to August 12, 2015. Using the 11 Gordon functional health assessments tool, data were collected by listening, interview, role participation, and physical examination. Three major health problems were identified, including acute pain, impaired physical mobility, and anxiety. Based on the identified health problems, the medical team provided necessary care, including education about the postoperative pain control method, assistance of physical activities placement, assistance of improving physical comfort, arrangement of doctors updating the disease progression, and provision of postoperative rehabilitation program. After discharge, the patient could perform daily activities independently. In addition, the patient returned to her favorite coffee bar working after a month. The health care team provided patients and her family memberswith the postoperative rehabilitation and discharge care plans to facilitate participation. At the same time, the patient and her family members followed the daily rehabilitation care schedule and adjusted the plan timely based on status of the patient. Before being discharged, the patient was assessed to ensure self-care ability after discharge. The results of this nursing experience provides a reference for caring patients with multiple fractures.

並列關鍵字

multiple fractures ； accident ； post surgery patient

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