一位腰椎狹窄接受腰椎融合術病人之護理經驗

Nursing Caring Experience a Patient with Lumbar Spinal Stenosis Undergoing Lumbar Fusion Surgery

羅心怡(Hsin-Yi Lo) ； 邱存梅(Tsun-Mei Chiu) ； 賀倫惠(Lun-Hui Ho)

《長庚護理》 29卷3期 (2018/09) Pp. 420-430

https://doi.org/10.6386/CGN.201809_29(3).0008

摘要

本文旨在探討一位80歲女性因腰椎狹窄接受腰椎融合術之護理過程，個案對手術過程不了解、擔心手術後是否能恢復而產生焦慮，手術後因肌力未立即恢復而感到無助並出現負面情緒。護理期間為2016年5月24日至2016年6月1日，藉由身體評估、觀察、會談與實際照護並運用Gordon十一項功能健康型態進行資料收集、評估及分析，確立其護理問題依時間順序為焦慮、疼痛、身體活動功能障礙及無力感。護理過程中提供衛教資訊、醫療團隊提供術前訪視、介紹相同的案例彼此分享經驗及聆聽音樂來減輕其焦慮；與醫師共同討論疼痛處置措施，以藥物、轉移注意力及維持舒適臥位等方式改善疼痛程度；與物理治療師共同擬訂復健目標，運用「脊椎手術後運動確認表」教導復健運動，增進肌力及身體活動功能；協助瞭解目前身體狀況、鼓勵並協助參與治療計畫及決策、減輕身體不適的症狀、確認支持系統、鼓勵尋求本身宗教信仰，增強正向信心改善無力感，幫助個案及早恢復健康，藉由此次護理經驗，提供照護類似個案之參考。

關鍵字

腰椎狹窄 ； 疼痛 ； 身體活動功能障礙 ； 焦慮 ； 無力感

並列摘要

This article reported the experience of caring an 80 years old female patient with lumbar spinal stenosis undergoing lumbar fusion surgery. The patient was worried about whether she could recovery from the surgery due to misunderstanding the process of surgery. The case even developed negative emotional state such as helplessness, and the muscle strength was not immediately restored after surgery. The data were collected through conducting physical assessment, observation, conversation, and direct care from May 24 to June 1, 2016. The Gordon's 11 functional health patterns were used as a guidance to perform evaluation and analysis. The identified health problems included: anxiety, pain, impaired physical mobility, and powerlessness. The caring plan included actively providing health education, introducing similar patients to share experiences, offering music to reduce anxiety, having the patient discussing pain treatment with physicians, providing pain medication, deviating patient's attention, and maintaining comfortable position to reduce pain level. We also collaborated with physical therapists to develop rehabilitation goals, and used a ＂Vertebral postoperative exercise check list＂ to guide rehabilitation activities to enhance muscle strength and maintain appropriate physical activity level. We helped the patient understand her current physical conditions, encouraged her participate in self-caring plans and decision-making process, alleviated her symptoms of discomfort, identified the support system, looked for support from her beliefs, enhanced her confidence level and re-enforced self-confidence to improve the feeling of powerlessness. This caring experience may provide a reference for other nursing staff who care for similar patients.

並列關鍵字

lumbar spinal stenosis ； pain ； impaired physical mobility ； anxiety ； Powerlessness

參考文獻

李秋香、顏文娟、林淑貞、徐彩育、賴慶祥(2014)。音樂介入對脊椎手術病人術前焦慮之影響。榮總護理。31(4)，343-351。

吳孟珊、蘇淑芬(2016)。動態內固定裝置（ISOBAR） 應用於腰椎融合手術之護理。護理雜誌。63(2)，120-126。

明金蓮、洪曉佩(2011)。急性疼痛評估與症狀護理。源遠護理。5(1)，11-16。

胡名孝、楊曙華(2014)。脊椎微創手術。台灣醫學。18(5)，529-535。

陳思遠、張欽凱(2014)。身體活動與肌少症。台灣醫學。18(3)，310-316。