照護一位髖部骨折老年人術後之護理經驗

本文旨描述一位65歲正邁入老年之女性患者，因跌倒造成左髖部骨折執行鋼釘內固定手術之護理經驗，個案於跌倒前生活皆可自理，發生意外後不僅面對傷口疼痛，亦要面對出院的身體活動受限，表示自己沒辦法再回到原本的生活，造成擔憂及焦慮，故引發筆者深入探討之動機。護理期間自2016年11月28日至2016年12月5日，照護期間運用會談、觀察、收集病歷主客觀資料，並以Gordon十一項健康功能評估，確立個案主要健康問題有：「疼痛」、「身體活動功能障礙」及「焦慮」等問題。針對個案健康問題，於護理過程中，指導個案可局部按摩及聽喜歡的音樂以分散注意力，患側冰敷等，以減輕疼痛；照會復健師共同策劃個別性復健計畫，參與及教導個案漸進式復健運動，除陪同個案執行復健運動以外，藉由衛教單張及圖片來增加病人理解及執行率，使個案能如期下床活動；鼓勵個案多表達、請家屬多陪伴及支持、介紹病友分享手術經驗、給予完整出院護理指導，並利用宗教信仰之支持，以減輕個案焦慮情形。筆者期望藉由此個案之照護經驗，提供外科臨床同仁照護類似個案之參考。

關鍵字

髖部骨折；疼痛；身體活動功能障礙；焦慮

並列摘要

This article is to describe the nursing experience of a 65-year-old female patient with left hip fractures caused by falling. The patient received surgical fixation with a sliding hip screw. The patient performed all activities of daily living independently before the fall occurred. After the incident, the patient reported inability to live independently due to pain and the impaired physical mobility after discharging. This case study was initiated by the author to further understand the patient's anxiety induced from the accident. The period of nursing care was from 28-Nov-2016 to 5-Dec-2016. The skills of interview, observation, and objective or subjective medical records collection were conducted during the nursing process. The patients reported pain, limitation in activity and exercise, and anxiety, evaluating by the Gordon 11 Functional Health Patterns. The nursing experience of the case focused on: instructing the patient to perform gentle massage, music listening for distraction, and applying ice packs to the hip for pain relief; developing the Individual Rehabilitation Plan collaborated with rehabilitation physicians and participating in the patient education for progressive rehabilitation; improving the compliance of the rehabilitation plan by increasing the patient's understanding through pictures and patient manual; encouraging the patient to verbalize feelings; encouraging the supports from family members; sharing experiences from the patient group; providing a comprehensive discharge instructions; alleviating patient's anxiety through the effect of religion. The author expected to provide a reference to the colleagues in the surgical department by this nursing experience case study.