一位血友病患者接受全膝關節置換術的照護經驗

The Nursing Experience of a Hemophilia Patient with Total Knee Replacement

本文係探討一位A型血友病患者，因為膝關節變形而入院接受膝關節置換術的護理過程。照護期間為2006年9月7日至9月16日。筆者經由與個案建立信任關係後，以溝通、會談及病歷查閱等方法收集資料，並以Gordon十一項功能性健康型態評估，發現個案有術後傷口疼痛、身體活動功能障礙、潛在危險性傷害以及長期性低自尊等問題。照顧期間筆者以主動關懷及同理心的態度，針對上述護理問題擬定個別性護理指導，教導疼痛緩解的方法，出血預防的輔助方式並協助執行適宜的復健運動等，使個案疼痛減輕、避免發生傷口持續出血情形、同時於術後一星期內能以拐杖行走，恢復原有的活動功能；另一方面運用正向回饋之技巧，肯定其優點及提供成功經驗以增加自信，並以同感心傾聽及協助個案釐清問題、確認其可行的解決方法，使個案能積極面對未來的生活。護理期間發現目前病房中並未有針對特殊疾病患者接受骨關節手術時之衛教單張，建議未來可考慮將此列入衛教發展項目之一。也期望藉此經驗分享，能提供護理人員照顧類似病患時之參考。

The article describes a nursing process of an A-type hemophilia patient with total knee replacement. The author used communication, interviews, chart reviews and Gordon 11 functional assessment to collect subjective and objective data from September 7 to September 16 in 2006. The patient’s problems were identified as the follows: acute pain, impaired physical mobility, risk for injury, and chronic low self-esteem. During the nursing process, the author provided individualized nursing care by giving pain-releasing methods, preventing wound bleeding, and offering rehabilitation project to reduce his pain, to avoid his wound bleeding, and to recover his mobility. In addition, the author also offered empathy, emotional support, and positive feedback to build the patient’s confidence. This nursing experience suggests we should have some education program for hemophilia patients. It is expected that the successful nursing experiences can be shared with other health care providers caring hemophilia patients receiving total knee replacement.