一位腰椎神經不完全損傷患者術後之護理經驗

Postoperative Nursing Experience of a Patient with Incomplete Spinal Cord Injury

彭惠敏(Hui-Min Peng) ； 吳素綿(Suh-Mian Wu) ； 鍾玉珠(Yu-Chu Chung)

《彰化護理》 27卷2期 (2020/06) Pp. 70-81

https://doi.org/10.6647/CN.202006_27(2).0011

摘要

本文旨在探討一位49歲女性個案從高處墜落而導致第十二胸椎及第一腰椎脫位合併脊髓損傷術後之護理經驗。護理期間自2018年3月13日至3月28日，運用Gordon十一項健康功能型態為評估架構，藉由觀察、溝通、身體評估及查閱病歷方式進行資料收集，確立個案主要的健康問題為身體活動功能障礙、焦慮及排泄型態改變。針對個案的護理問題提供個別性護理措施，與跨團隊復健小組人員共同擬訂肢體復健計劃，協助與指導漸進式主動與被動關節運動、坐姿平衡及阻力訓練，預防關節攣縮及維持皮膚完整性，同時透過主動關懷、傾聽及鼓勵表達內心感受，運用支持系統提供情緒支持以減輕焦慮。利用女性導尿模具示範與回覆示教方式進行間歇性導尿訓練，增加個案之自我控制感及協助個案克服疾病所帶來之衝擊及生活改變，學習與殘障共存，個案最後能正向與積極面對未來復健治療。

關鍵字

脊髓損傷 ； 身體活動功能障礙 ； 焦慮 ； 排泄型態改變

並列摘要

This paper describes the postoperative nursing experience of a 49-year-old female who fell from a height and suffered of the 12th thoracic vertebra and 1st lumbar vertebra dislocation combined with spinal cord injury. The nursing period was from March 13 to March 28, 2018. We used Gordon's 11 functional health patterns to evaluate through observation, conversation, physical assessment, and chart review. The health problems included impaired physical mobility, anxiety, and impaired urinary elimination. The author provided the following individual nursing interventions; collaborating with a transdisciplinary rehabilitation team to implement the lower extremities rehabilitation such as passive and active range of motion (ROM), sitting balance, and resistance training exercises to prevent arthrogryposis and maintain skin integrity. We applied caring, listening, and verbal encouragement to guide the client to express of inner feeling, and using support systems to provide emotional support to reduce anxiety. Teaching and repeated demonstration of intermittent catheterization procedure using a f female catheterization model, increase the sense of self-control of the client and help to overcome the impact of the disease and life change, coexist with learning and disability, and the client can be positive facing rehabilitation treatments in the future.

並列關鍵字

spinal cord injury ； impaired physical mobility ； anxiety ； impaired urinary elimination

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