一位多重外傷合併急性壓力後情緒障礙病人之加護護理經驗

Nursing Care for an ICU Patient Suffering from Acute Pain and Post-traumatic Stress Disorder after Multiple Traumas

傅琬瑩(Wan-Ying Fu) ； 蕭偉伶(Wei-Ling Hsiao)

《臺大護理雜誌》 17卷1期 (2021/01) Pp. 66-77

https://doi.org/10.6740/NTUHJN.202101_17(1).0007

摘要

本文為照護一位多重外傷個案合併急性疼痛以及創傷後壓力症狀之加護護理經驗。於2018年5月9日至17日照護一位壯年期，因車禍造成工作停頓與身心巨大改變之個案，引發探討動機。以整體性評估，經由直接照護、筆談、家屬會談、查閱病歷等方式收集資料，確立個案主要有「低效性呼吸型態」、「急性疼痛」及「急性壓力後情緒障礙」之健康問題。護理照護期間，密切監測呼吸型態，教導有效深呼吸咳嗽，改善低效性呼吸型態。於急性期與醫療團隊提供藥物與非藥物護理處置改善疼痛問題。創傷後病人情緒激動、明顯負面情緒，使用中文版簡式創傷後壓力疾患量表，有效地評估急性壓力後創傷症候群之風險，結合心理師跨團隊運用以家庭為中心的照護，藉由相互間的支持強化個案的復原力，走出創傷的陰霾，並增加自我控制的能力，有效協助降低個案心理困擾。建議第一線照護的重症護理人員，應具備篩檢創傷後壓力疾患風險和提供急性照護之能力，以能有效提供更全面的身心照護。

關鍵字

多重外傷 ； 創傷後壓力症候群 ； 急性疼痛 ； 低效性呼吸型態

並列摘要

This article describes the nursing care of a patient suffering from acute pain and post-traumatic stress disorder after multiple traumas. Data were collected through interviews with the patient and his family members, observation, direct care, and medical chart review from May 9 to May 17, 2018. Based on a holistic assessment and SPAN-C (startle, physiological upset, anger, and numbness-Chinese version) screening tool, health problems of an inefficient respiratory pattern, severe pain and post-traumatic stress disorder were identified. We provided a comprehensive breath plan to improve the patient's inefficient respiratory pattern, used pharmacological and nonpharmacological interventions to help the patient deal with severe pain and provided assessment with the SPAN-C tool for post-traumatic stress disorder. The nursing care included facilitating discussions among multidisciplinary teams, providing family-centered care, and teaching the family to support the patient. After mind-body holistic care, the patient's health status recovered well. Based on this nursing care experience, use of the SPAN-C tool is suggested to assess the possibility of posttraumatic stress disorders for patients with traumatic injury. In addition, cooperation with team members to provide an appropriate care plan and interventions to improve the quality of care is necessary.

並列關鍵字

multiple traumas ； post-traumatic stress disorder, PTSD ； acute pain ； ineffective breathing pattern