一位橫紋肌溶解症併發急性腔室症候群病患之加護護理經驗

ICU Nursing Experience for a Patient with Acute Compartment Syndrome Secondary to Rhabdomyolysis

本文是探討一位橫紋肌溶解症併發急性腔室症候群病患之加護護理經驗，筆者於2007年12月1日至12月18日護理期間，藉由直接照護個案、會談及身體評估等方式進行資料收集，運用羅氏適應模式作為護理評估指引，經收集資料，分析確立個案有組織完整性受損、潛在危險性感染、組織灌流改變及創傷後反應等健康問題。護理過程提供個案傷口護理，控制體溫，預防感染，適當抬高患肢促進血液循環，促進復原。期望藉此護理經驗之分享，以提供護理人員臨床照護之參考。

This case study reported the nursing experience for a patient with acute compartment syndrome secondary to rhabdomyolysis at the intensive care unit. The period of nursing care was from December 1 to December 18, 2007. With Roy's adaptation model, nursing problems were identified through direct patient care, case interview, and physical examination. The addressed nursing diagnosis were impaired skin integrity, risk for infection, altered tissue perfusion, and post-trauma response. Nursing interventions included wound care, control of body temperature, prevention of infection, and elevation of affected body parts for promotion of circulation and healing. This article offered nurses a reference for caring for a patient with acute compartment syndrome secondary to Rhabdomyolysis.