照顧一位全肺切除術後合併脊髓梗塞中年婦女病人之加護經驗

The Nursing Experience of Intensive Care for a Women Patient Suffering Spinal Cord Infarction after Receiving Pneumonectomy Surgery

葉秋燕(Chiu-Yen Yeh) ； 楊麗瓊(Li-Chiung Yang) ； 陳恩惠(En-Hui Chen) ； 廖淑貞(Shu-Chen Liao)

《馬偕護理雜誌》 10卷2期 (2016/07) Pp. 73-88

https://doi.org/10.29415/JMKN.201607_10(2).0007

摘要

本文係描述一位肺癌施行右全肺葉切除個案，術後發現脊髓梗塞導致下半身癱瘓之照護經驗，個案年僅44歲中年婦女面臨下半身癱瘓，對其內心產生衝擊甚鉅。護理期間為2014年10月18日到10月24日，筆者藉由觀察、會談、病歷檢閱及身體評估收集資料，運用Gordon十一項健康功能性評估工具，確立個案有：1.氣體交換障礙、2.身體活動功能障礙、3.焦慮、4.缺乏適應和問題解決能力等健康問題。護理過程中教導肺部復健運動融入深呼吸、咳嗽，藉由誘發性肺計量器及隨手可得的電子產品，使復健活動增加趣味性提升遵從度；配合翻身活動及利用點滴軟袋負重，促使個案執行主動運動並強化肌力，鼓勵家屬參與照顧，學習被動式全關節運動、按摩等技巧；醫護團隊主動提供個案和家屬疾病相關資訊與護理指導，鼓勵抒發情緒，經由宗教的心靈寄託及音樂放鬆，轉移疾病帶來的壓力，以減輕焦慮；透過社工師提供多元化的社會資源並協助加入民間團體，聽取病友經驗分享，有助於傷後調適期的引領，期將此護理經驗提供日後護理同儕照護此類個案之參考。

關鍵字

全肺切除 ； 脊髓梗塞 ； 癱瘓

並列摘要

This article described a nursing experience for caring right pneumonectomy patient who suffered spinal cord infarction leading to paralysis all over lower body. This patient was a 44 year- old women and needed to face this huge change crushing her a lot. The period of nursing care started from October 18 to October 24, 2014. The Gordon Functional Health Assessment guide was used to identify the health problem. And the data collection was done by observation, conversation, physical assessment and clinical care to this patient. The health problem included: 1. gas exchange impaired, 2. physical mobility impaired, 3. anxiety, 4. ineffective individual coping. Pulmonary rehabilitation was necessary in this phase by using inductive Incentive Spirometer and electronic products which increased the fun and enhanced compliance, in order to increase her breathing capacity. Some physical exercises were engaged in this rehabilitation, such as changing position of bed rest and placing heavy water bag on her abdominal enhancing the strength of abdominal muscles for breathing. Her family members were encouraged to participate in her daily actives, and learned the skills of passive joint movement, massage and other techniques. Health care team provided information for them on disease, caring details, emotion expressing, soft music, and religious and spiritual sustenance for reducing stress and anxiety of patient. Introducing support groups related to this disease to her and her families to shares some experiences and helps them get through this difficulty. This can enhance them to have the capability of coping and problem solving.

並列關鍵字

pneumonectomy ； spinal cord infarction ； paralysis