一位紅斑性狼瘡合併細菌性關節炎患者之護理經驗

Nursing Experience of a Patient with Systemic Lupus Erythematosus Combining Septic Arthritis

本報告在描述一位急性細菌性關節炎病患，於住院治療期間，初次被診斷罹患紅斑性狼瘡之護理過程。個案於住院期間接受膝關節清瘡合併滑膜切除術，並經歷高燒、疼痛及感染等問題，護理期間以戈登（Gordon）十一項功能性健康型態為評估工具，藉由觀察、會談與身體評估等技巧收集資料後，確立個案有體溫過高、疼痛、危險性感染及身體活動功能障礙等護理問題。在與個案及家屬建立良好的治療性人際關係後，運用護理知識，並結合醫療團隊給予個案整體性與持續性的護理，促使個案症狀緩解與維持舒適，並持續復健活動，進而達到恢復關節功能及減少後遺症的目的。希望藉此個案報告與護理人員分享，在照護類似的關節炎病患時，應具備足夠之專業護理知識，才能於第一時間發現病患發病的引發因子，並予即時之處置及護理；此外，除處理病患感染與發燒的生理問題外，並應鼓勵病患面對疾病，儘早以漸進式方式進行復健運動，以促進關節功能之恢復。

This report describes the nursing experience of a patient suffering from acute septic arthritis who was diagnosed systemic lupus erythematosus (SLE) for the first time during hospitalization. The patient received debridement with synovectomy in the hospital, and then developed fever, pain, and infection. The eleven-item Gordon Functional Health Measure was employed as the assessment tool. By means of observation, interview and physical assessment, the patient was confirmed to have a number of nursing problems, including hyperthermia, pain, dangerous infection, and ambulatory impairment. After establishing good therapeutic rapport with the patient and family, a holistic management was then achieved using appropriate nursing knowledge and an interdisciplinary approach. The optimal goals were to provide symptomatic relief, and maintenance of comfort, thereby attaining joint functions while reducing complications. It is hoped that by sharing this case report with nursing personnel one shall equip with adequate professional knowledge when caring patients with similar arthritic diseases so that the risk factors could be promptly detected and intervened. In addition to managing physiological problems that infections and fevers may bring about, patients should be encouraged to face their diseases positively and commence progressive rehabilitation exercise as early as possible, thereby restoring joint functions.