照顧一位反覆跌倒股骨頸骨折病人之護理經驗

本文探討一位78歲女性中風後反覆跌倒致股骨頸骨折，入院接受半人工髖關節置換術之護理經驗。病人擔心手術後的失能和依賴，會造成家庭負擔而情緒低落，引發撰寫動機。護理期間2019年9月16日至9月26日，以Gordon十一項健康功能型態進行整體性評估，確立主要健康問題：身體活動功能障礙、潛在危險性跌倒及焦慮。照護期間與病人及家屬建立良好護病關係，關懷與陪伴病人面對跌倒後失能衝擊，引導建立信心面對困難，在醫療團隊幫助下強化照顧者照護能力，預防髖關節脫位且指導需遵從術後正確姿勢及移位技巧，以減輕焦慮，同時提供骨質疏鬆護理指導及居家無障礙環境準備，增強活動能力與信心，積極轉銜社區型醫院進行2週急性後期復健，預防再跌倒。此次護理經驗深感出院準備及PAC轉銜對骨折病人是非常重要的，筆者冀望藉由此照護經驗，提供反覆跌倒之高齡股骨頸骨折病人護理照護之參考。

關鍵字

股骨頸骨折；半髖關節置換術；跌倒；復健；急性後期照護

並列摘要

This article reports the experience of nursing a female patient aged 78 years who accepted a hemiarthroplasty operation after a fall that led to a right femoral neck fracture. The concerns that the patient had, such as a fear that her disability and dependence after the operation might burden her family, motivated the author to write this article. During the nursing period of September 16 to 26, 2019, the author collected subjective and objective information by observing, conversing, and interacting with the patient and performing physical assessments; Gordon's 11 functional health patterns assessment was also applied to systematically assess the patient's condition. The results revealed that the patient had problems regarding physical mobility, anxiety toward falls, and fall hazards. During the nursing process, the medical team empathized with the patient and accompanied the patient in coping with a possible disability and in establishing a good relationship with her family members. The caregivers' care abilities were also enhanced by the provision of instruction by the medical team on postoperative posture and displacement skills, on caring for people with osteoporosis, on preparing an accessible home environment, and on how to prevent falls and hip dislocation. These practices reduced the caregiver's stress and the patient was ultimately successfully transferred to the community hospital to proceed with 2 weeks of postacute care rehabilitation, which could increase the patient's physical activity, prevent disability, and reduce anxiety. In this case, the author was deeply aware of the importance of discharge planning and referral following acute care, and, in presenting this report, the author hopes to share this nursing experience to help clinicians better care for patients with femoral neck fracture.

並列關鍵字

femoral neck fracture ； hemiarthroplasty ； falls ； rehabilitation ； postacute care

參考文獻

丁睿宇、陳彥方、陳慧娟、黃冠樺、高木榮(2019)．髖關節骨折急性後期復健照護之長期成效．北市醫學雜誌，16(3)，220-231。

洪政豪、蔡承憲、陳亮宇、彭莉甯(2017)．老年跌倒之評估、介入與預防．台灣老年醫學暨老年學會雜誌，12(2)，91-103。

張軒睿、張尹凡、張秦松、陳全裕、劉晏孜、林盈利、吳至行(2019)．某鄉村社區女性長者反覆跌倒之危險因子探討．台灣老年醫學暨老年學會雜誌，14(1)，1-15。

詹琪文、白麗雯、黃玉鈴、李雪玲(2014)．以系統文獻回顧法探討全髖關節置換手術健康指導措施成效．領導護理，15(4)，22-31。

Copanitsanou, P. (2019). Community rehabilitation interventions after hip fracture: Pragmatic evidence-based practice recommendations. International Journal of Orthopaedic and Trauma Nursing, 35, 100712.

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照顧一位反覆跌倒股骨頸骨折病人之護理經驗

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