照護一位腿部創傷併發急性腔室症候群個案之護理經驗

A Nursing Experience of a Patient with Fractured Thigh Complicated by Posttraumatic Acute Compartment Syndrome

陳姝娟(Shu-Chuan Chen) ； 林美蓮(Mei-Lien Lin)

《志為護理-慈濟護理雜誌》 12卷2期 (2013/04) Pp. 102-111

摘要

本文探討一位男性因工作意外，左脛骨、右股骨閉鎖性骨折併發腔室症候群，接受多次清瘡手術，面臨創傷肢體可能截肢，於身、心層面受雙重打擊的護理經驗。筆者於2010年3月22日至4月15日期間，運用Gordon十一項功能性健康型態評估，由觀察、會談、傾聽技巧收集資料，發現個案健康問題有組織完整性受損、急性疼痛、身體活動功能障礙及焦慮。護理過程，生理方面提供完整傷口照護計劃，協助攝取促進傷口癒合之營養素；提供深呼吸及轉移注意力技巧，減少疼痛感；運用手拉桿，移動身體發揮肢體活動最佳效能；心理方面以主動關懷、同理心技巧，確認個案關切問題，透過醫師詳細解釋，增加個案對治療的參與，最終有效減緩焦慮情緒。

關鍵字

腿部 ； 創傷 ； 腔室症候群

並列摘要

The article discussed the nursing experience of a male patient who experienced occupational accident, resulted in fracture in the left tibia and the right greater trochanter, complicated by acute compartment syndrome. The patient experienced several debridement surgeries and faced potential risk of posttraumatic limb amputation, causing physical and psychological double-whammy during the period of hospitalization. During the nursing process from March 22 to April 15, 2010, the author collected health-related information by observation, conversation, listening to the patient, and evaluating the patient through Gordon 11 health functional tools. Four health problems were identified, which included impaired tissue integrity, impaired physical mobility, acute pain, and anxiety. Regarding the physiology of the patient, the following nursing measures were taken: drafting a holistic wound care plan, assisting in the intake of nutrient to promote wound healing, teaching deep breathing exercise and skills to divert attention to reduce the acute pain, and introducing tension bar to encourage physical activities and improve limb movements. Psychologically, the team initiated active care, empathy, confirmed the patient's concerns, and increased the patient's participation in the treatment through detail descriptions by the doctor. As result, the patient's anxiety was successfully relieved.

並列關鍵字

acute compartment syndrome ； thigh ； trauma