照顧一位髖關節缺血性壞死病患行關節置換術之護理經驗

A Nursing Experience in a Patient with Femoral Head Vascular Necrosis after Hip Replacement

謝雨帆 ； 楊麗慧

《領導護理》 8卷1期 (2007/06) Pp. 69-77

https://doi.org/10.29494/LN.200706.0007

摘要

本文主要探討一位髖關節缺血性壞死病患行關節置換術後，因害怕再脫位、擔憂術後無法自我照顧及喪失日後工作能力，而導致執行復健運動及下床活動意願不高的負向情形。護理期間自2005年4月28日至2005年5月9日，以Gordon十一項健康功能評估爲架構，藉由觀察、會談、身體評估等方式收集資料，確立個案有害怕、急性疼痛及身體活動障礙等護理問題。筆者運用護理過程，解決個案住院期間的身心問題，協助個案在生理調適減輕術後疼痛、面對術後的日常活動與復健問題、克服復健擔憂、防範脫位，提供完善的護理照護與諮詢，經由護理指導、示範、回覆示教，個案於2005年5月3日下床練走，直至2005年5月8日出院前未有脫位情形發生，在出院後門診及電話追蹤約3個月，自述生活已步入正軌且無發生脫位情形。筆者期望藉由此個案之經驗，可提高護理人員對行髖關節置換術之病患在術後害怕脫位及自我照顧問題的重視，並透過護理功能協助病患與家屬順利渡過此次經驗，早日恢復手術前之角色功能並提供同仁日後照護上之參考。

關鍵字

全髖關節置換術 ； 脫位 ； 害怕 ； 疼痛

並列摘要

This paper explore the situation of a patient with femoral head vascular necrosis after hip replacement. Because of being afraid of re-dislocation, also worrying about being unable to care for himself and losing his job later, the patient had a motivation for rehabilitation and ambulation. The author cared for this patient as his primary nurse from April 28 to May 9, 2005, The Gordon 11-item Functional Health Pattern was used as an assessment tool to collect data through observation, interview, and physical assessment. Three problems are established: fear, acute pain and impaired physical mobility.
During the hospitalization period, the author utilized nursing processes to help the patient to adjust physical posture to relieve pain, to perform daily living activities, to overcome rehabilitation anxieties, to prevent dislocation, and to provide comprehensive nursing care and information update. Through teachining, demonstration and repeated-demonstration, the patient was able to perform out of bed ambulation without dislocation till the day before his discharge. After three-month out-patient and telephone follow up, the patient stated that he could ambulate freely without dislocation and had resumed previous role function.