照護一位接受人工膝關節置換術個案之護理經驗

Nursing Care Experience in a Patient with Total Knee Arthroplasty

本文為探討一位老人因罹患骨性關節炎多年，導致右膝關節變形及跛行，接受人工膝關節置換手術。筆者自2008年1月20曰至2008年1月27曰照護期間，經由觀察、會談、傾聽、病歷查閱等方式收集資料，運用Gordon十項功能性健康模式做整體性評估，確認個案的主要健康問題有焦慮、疼痛、身體活動障礙及便秘等。護理措施包括：提供台語版多媒體影音光碟、衛教手冊、人工膝關節模型來解說及穴位按壓以減輊焦慮；以芳香療法、音樂療法、放鬆技巧等來緩解傷口疼痛；說明計劃性復健運動的重要性，並示範復健運動的分解動作，來回復及維持膝關節的活動度，使個案儘快恢復關節的活動功能；以穴位指壓、腹部按摩來改善排便型態。針對個案的護理問題，提供適當的護理措施，減輕個案在生理及心理的不適，使個案在手術後能早曰恢復曰常活動功能。The present study aims to explore the nursing care for a patient with right knee joint deformity and limping for years, who underwent right total knee replacement. During the nursing period (Jan/20/ 2008 to Jan/27/2008), data was collected through observation, talking, listening, and anamnesis, We evaluated the patient using Gordon ’ s functional health assessment. The most obvious problems during hospitalization were anxiety, pain, impaired physical activity, and constipation. The nursing intervention included: (1) a teaching manual, multimedia videodisc device, artificial knee joint model, and acupressure massage to relax anxiety; (2) aromatherapy, music therapy and relax skills to release wound pain; (3) the explanation of the importance of scheduled rehabilitation and the demonstration of the rehabilitation movements to recover and maintain the range of motion of knee joint; and (4) the use of acupressure and massage on abdomen in order to improve stool. Based on the individual problem, we provided appropriate nursing care to release the physical problem and psychological discomfort, and lead the patient back to the normal daily activity.