一位年輕男子行全膝關節置換術之手術全期護理

A Perioperative Nursing Experience of Caring for a Patient Undergoing a Total Knee Replacement

本文旨在敘述一位創傷性退化性關節炎之年輕男子接受右膝全膝關節置換術之手術全期護理。護理期間自2012年2月21日至29日，運用會談、觀察、身體評估及查閱病歷方式收集資料，以手術全期照護為基礎，評估個案之生理、心理、社會、靈性及發展等體整層面之健康問題，確認個案主要的護理問題，包括焦慮、潛在危險性手術情境的傷害及潛在危險性感染。筆者在手術前期，經由術前訪視，以傾聽、主動關懷及鼓勵個案，並提供個別性之手術前與手術後相關衛教，緩解個案面對手術之焦慮情緒，於手術中期依照手術室標準流程提供安全的防護措施預防潛在危險性傷害，手術後持續遵守無菌技術及傷口護理，個案於手術結束後無任何皮膚破損或神經及肌肉損傷情形，以及手術傷口無感染發生。期望往後對於有關創傷性退化性關節炎行全關節置換手術病人之手術全期護理照護上有所助益。

This case study explores a perioperative nursing experience of caring for a young male with traumatic degenerative osteoarthritis undergoing a total knee replacement. The nursing period was from February 21 to 29, 2012. The author collected data through interview, observation, physical examination and medical record review. With an assessment of the patient's care needs in physical, emotional, social, spiritual and developmental aspects, the identified major care problems were anxiety and potential risk for operative injury and infection. During the pre-operative visit, the author provided authentic listening, active caring, and individualized pre-operative and post-operative patient education to relieve the patient's anxiety. The patient was also encouraged to ventilate his concerns. During the operation, the operation standards were followed to ensure the safety and protection of procedures and the prevention of a potential risk of injury. Continuous implementation of post-operative sterile techniques and wound care prevented the patient from experiencing a skin breakdown, pressure ulcer or incisional infection. The author expects this nursing experience will help guide care for patients receiving total knee replacements due to traumatic degenerative arthritis.