身體評估於國民小學健康中心的運用與建構

學童主要的死因包括：事故傷害、惡性腫瘤、心臟疾病、肺炎、腦血管疾病及自殺等，校園中這些疾病需要學校護理人員運用身體評估技巧與批判性思考(critical thinking)進行疾病初步篩檢，以提供更有效率的健康照顧或轉介醫療院所。緊急狀況下護理人員能熟練的評估學生的意識狀況、昏迷指數(GCS)、生命徵象、呼吸型態及皮膚濕冷等休克症狀，在第一時間內將學生送醫並維持生命，可以挽救學童幼小的生命，避免殘疾的發生。其次，疾病盛行率的評估，緊急處理集體食物中毒，避免傳染病擴大，在公共衛生有重要的功能。一般狀態下，學校護理人員經由視力健康篩檢，注意學生潛在的健康主訴，評估學生身體外觀、行走步態、心音、呼吸音、腸音及腹部柔軟度，即能簡易篩檢其健康問題，所花費的時間僅2-5分鐘，卻能守護學生的健康。緊急狀態下，則需熟悉快速的腦神經、心肺功能評估，確立疾病的嚴重度而有所根據才能依緊急傷病救護的原則送醫。本文介紹身體評估各系統簡易評估重點，緊急與一般狀況下評估內容，以提供學校護理人員辨別學童疾病之參考。

關鍵字

身體評估；學校護理人員；健康服務

並列摘要

The main causes of childhood death were accidents, malignant cancer, heart diseases, pneumonia, cerebral vascular diseases and suicides. School nurses need to apply physical assessments and make a critical thinking to detect pre-existing and extending problems. Sometimes, it would also be necessary to transfer the patients to a hospital for better and more efficient cares. In an emergency situation, school nurses are proficient in performing physical examinations that detect symptoms of shock including conscience level, GCS coma scale, vital signs such as blood pressure, body temperature, heart rate, and breath. The school nurses have to make a critical decision about whether to take care of the ill students or transfer them to a better medical attention. On the other hand, it is also important to detect highly contagious diseases, cases of food poisoning, and prevention of illness from contamination. Physical assessment protocol in school health centers should not only allow the nurses to be skilled in physical assessment skills but also to prepare the equipments for emergency situations. Physical assessment skills are the foundation of medical care, and also the responsibility for school nurses. This document will introduce a more efficient way about simple physical examinations and the content of the evaluations between general and emergency situations. Over all, it will provide valuable suggestions about how to verify different symptoms with children under critical thinking for nursing schools

並列關鍵字

physical assessment ； school health nurse ； health service

參考文獻

張麗春、洪麗玲、李怡娟、林麗美、鄒治儉、侯淑雲(2005)。校園肺結核管理。學校衛生。47，71-85。

Anderson, E. W.,Valerio, M.,Liu, M.,Benet, D. J.,Joseph, C.,Brown, R.(2005).Schools' capacity to help low-income, minority children to manage asthma.Journal of School Nursing.21(4),236-242.