照顧一位第二頸椎損傷個案使用頸椎外固定器之護理經驗

Nursing Experience in Caring for an Epistropheus Fracture Patient by Using Halo-vest

第二頸椎骨折之治療，通常使用頸椎外固定器（Halo-vest）以維持頸椎穩定性，但顱釘部位之潛在感染風險，其笨重的外觀可能影響個案造成舒適情況改變及心理問題。本文介紹照顧一位車禍導致第二頸椎齒狀突骨折使用Halo-vest個案之護理經驗，筆者於2007年5月12日至5月17日照護期間，運用Gordon 11項健康功能評估，藉由觀察、會談、身體評估、病歷查閱等方式收集資料，歸納個案具有睡眠型態紊亂、身體心像改變及潛在危險性感染之健康問題。經由建立良好的治療關係，應用傾聽及回覆示教等方式，依各項問題提出個別性之護理措施後，使個案於護理期間內顱釘部位無感染發生，且能回復住院前之睡眠型態，並能正向地面對其身體心像的改變。筆者期冀本文能作為護理同仁日後照護此類個案之參考。For sustaining the stability of the cervical vertebra, Halo-vest is the main therapy equipment of epistropheus fracture. However, the risks of pin-site infection and the bulky appearance of Halo-vest may lessen patients' comfort and affect their psychological well-being. This case study reports a car accident patient who used Halo-vest to help his epistropheus fracture cure. The subject was taken care by the author from May 12 to May 17, 2007. The author analyzed the data by applying Gordon 11 functional health patterns. These data were collected from clinical observation, interviews, physical assessment and chart review. The author identified several nursing problems, including the risk of infection, sleep disturbance, and a change of body image. The author established a trustworthy relationship with the subject by providing individualized nursing care to prevent pin-site infection, to help the subject recover from sleeping disturbance, and to face his change of body image positively. This case study can serve as a nursing model for epistropheus fracture care.