脊髓損傷失能長者照護經驗－個案報告

Nursing of a Disabled Elderly Person with Spinal Cord Injury: A Case Report

簡郁珊(Yu-Shan Chien) ； 陳淑暖(Shu-Nuan Chen) ； 陳頌云(Sung-Yun Chen) ； 蔡衣帆(Yi-Fan Tsai)

《北市醫學雜誌》 17卷4期 (2020/12) Pp. 490-501

https://doi.org/10.6200/TCMJ.202012_17(4).0012

摘要

一位74歲男性因脊髓損傷導致下半身癱瘓於2018年4月3日至5月1日住院接受治療。在照護病人期間，運用身、心、靈、社會評估模式，確立其主要健康問題為：（一）呼吸道清除功能失效與痰液量增加，及無效性咳嗽；（二）身體活動障礙與脊髓損傷導致肌力減弱；（三）無望感與面對疾病無進展、日常生活需人協助。經由背部扣擊、抽痰護理指導，讓個案能把痰液咳至氣切口外，使胸部X光改善；提供脊髓損傷照護措施及跨團隊資源，使個案上肢肌力由3－4分增加至5分並可自行翻身；召開跨團隊會議，提供相關居家醫療及長照資源讓個案及家屬可以使用。脊髓損傷病人常面臨許多健康問題的威脅，希望藉由此護理經驗提供臨床參考，以提升脊髓損傷失能長者之照護及生活品質。

關鍵字

脊髓損傷 ； 呼吸道清除功能失效 ； 身體活動障礙 ； 無望感

並列摘要

This report describes the nursing experience of a 74 years old patient with spinal cord injury. The nursing period was from April 3 to May 1, 2018. By using a body-mind-spirit-society assessment model to observe, interview, conduct physical examinations, provide direct nursing, and collect data, we ascertain the patient's health problems as: (1) loss of airway clearance function, increase of mucus, and ineffective coughs related; (2) impaired physical mobility and decrease of muscle strength due to spinal cord injury related; (3) hopelessness, lack of health progress, and requiring assistance related. The lung cough ability and chest condition as shown on X-ray were improved after the implementation of chest percussion and suction care. We provided spinal cord injury care and medical team resources, and enhanced the patient's muscular strength from 3-4 grade to 5 grade which enable him to turn over without assistance. We also hold medical team meetings to provide relevant home medical and long-term resources to increase the quality of health care services to this case and his family. We expect this clinical experience to provide a reference for caring SCI patients.

並列關鍵字

spinal cord injury (SCI) ； Ineffective airway clearance ； impaired physical mobility ； hopelessness