- 期刊
照顧一位主動脈瘤術後下半身癱瘓之護理經驗
Nursing Experience of a Patient with Aortic Aneurysm Post-operation Resulting Paraplegia
摘要
本文描述照顧一位74歲男性行血管腔內主動脈瘤修復手術，術後因合併脊髓缺血導致下半身癱瘓，面臨神經性疼痛、呼吸肌損傷、感覺及運動功能會喪失，及不如預期的病情進展，陷入負向情緒之照護過程。筆者於2020年06月24日～2020年07月12日護理期間，藉由觀察、會談及身體評估收集主客觀資料，依據Gordon 11項健康功能型態為評估工具，確立有「疼痛」、「低效性呼吸型態」、「自我照顧能力缺失」及「無望感」等健康問題。運用物理治療及輔助療法改善疼痛；教導肺部復健運動及胸腔物理治療，強化呼吸肌及促進肺擴張，預防肺部感染；學習日常生活照護技巧，以提升自我照顧能力；建立治療性護病關係，以同理關懷態度給予正向鼓勵，使能正向面對疾病，順利出院轉照護機構。期望藉此分享，在未來照護此類個案，能掌握其照護需求，提升護理照護。
並列摘要
This study describes the healthcare process for a 74-year old male patient with paraplegia resulting from endovascular aneurysm repair after surgery complication spinal cord ischemia, be confronted with neuropathic pain, respiratory muscle damage, loss of sensory and motor function and below expectations progression of the disease, fall into a negative emotions. During the nursing care period from June 24 to July 12, 2020, the assessment tool "Gordon's 11 Functional Health Patterns" was applied in combination with observation, interview and physical examination skills to collect data. Health issues were then determined including pain, ineffective breathing pattern, self-care deficit and hopelessness. The pain was improved by physical therapy and an adjuvant therapy. The pulmonary rehabilitation program and chest physical therapy were delivered to strengthen respiratory muscles and improve lung expansion, in order to prevent lung infection. Meanwhile, the patient was instructed with daily living skills to enhance his self-care ability. We also established a therapeutic nurse-patient relationship to provide the patient with empathy and encouragement, elicit his positive attitude fighting against the disease physical and psychological illness, therefore facilitate successful discharge and transfer to a nursing long-term care facilities. By sharing the nursing experience, the future care for such type of patient can be improved.