一位創傷斷肢青少女之手術全期護理經驗

Perioperative Nursing Experience of a Female Adolescent with Tramatic Amputation

本篇個案報告是探討一位青少女因車禍外傷造成左股骨幹骨折及左小腿碾傷截斷經歷創傷後第二次手術全期之護理經驗。筆者為手術室外傷科護理師，透過參與性觀察、個別訪談及運用手術全期照護概念為架構來進行護理評估，並參與創傷斷肢手術急性階段實際照護後，發現個案主要健康問題如下：(1)創傷後反應，與車禍事故傷害造成斷肢創傷有關；(2)潛在危險性手術期間擺位之傷害，危險因子為側臥位、清創手術、麻醉與環境因素；(3)急性疼痛，與術後傷口造成組織創傷有關。筆者在手術全期照護過程中提供個別性、連續性及整體性護理，運用同理心感受個案面對車禍創傷與手術的情緒衝擊，給予適當護理措施如鼓勵、陪伴、密切觀察與監測安全及舒適措施，以協助個案順利適應手術全期。由於創傷後反應的護理評估是一個持續動態的過程，建議未來護理人員照顧類似個案時應及早適當處理創傷後反應，以避免形成創傷後壓力症候群，並提供手術全期之個別性照護以協助個案達有效適應。

This case report was the perioperative nursing experience of a female adolescent who underwent second operation for fracture of left femur and crush injury of left leg by traffic accident. The first author is a nurse working in the operation room. The authors used observation and individual interview, applied the framework of perioperative nursing concepts to collect and analyze data. Perioperative nursing care of tramatic amputation in acute phase was involved. The client’s major health problems were as follows: (1) Post-trauma response (PTR), related to traumatic amputation by traffic accident; (2) Potential risk for perioperative positioning injury due to lateral decubitus position, debridement surgery, anesthesia and environmental risk factors; (3) Acute pain due to surgical trauma of tissues. Through the perioperative period, we provided individualized, continuous and comprehensive perioperative nursing care. First, we applied empathy to perceive her emotional impacts induced by trauma and surgery. Then, we assisted the case to face the challenges of surgery effectively by encouragement, company, closed observation, and monitoring patient’s safety and comfort. For assessment of PTR was a dynamic process, we suggested nurses which caring similar cases should intervene in advance to avoid post-trauma stress disorder (PTSD), and should assist these patients could obtain effective adaptation by providing perioperative nursing care.