一位全髖關節置換術個案之手術全期護理經驗

A Perioperative Nursing Experience of a Patient Underwent Total Hip Replacement

本文主描述一位因退化性關節炎行全髖關節置換術個案之手術全期護理經驗。於2014年11月3日至11月11日，利用術前病房訪視、手術期間直接照護，及術後病房探視，並運用觀察、會談、身體評估及病歷查閱等收集資料，以手術全期照護模式為指引進行整體性評估，歸納出個案有焦慮、潛在危險性傷害、疼痛及身體活動功能障礙等健康問題。運用術前訪視的陪伴及擬訂個別性護理計畫，以手術相關資訊增進信心並減低其焦慮；手術全程密切監控，避免手術傷害之發生；藉由藥物、調整呼吸及轉移注意力以緩解疼痛。術後則教導下肢全關節運動，並在其出院時，提供住家附近可運用的社會資源，協助返家後居家照護，使個案早日恢復原有的生活。期望藉此個案的護理經驗，提供護理人員日後臨床照護之參考。

This report described an a perioperative nursing experience of a degenerative arthritis patient who received total hip replacement. This patient was hospitalized between 3rd and 11th November, 2014. The author collected data via preoperative ward visit, direct operative care, and postoperative visit, using observation, interviews, physical assessment, and chart review, and conducted a comprehensive assessment with perioperative nursing model as guideline. It was concluded that this patient had operation-related health problems such as anxiety, potential risk of injury, postoperative pain, and impaired physical mobility. We engaged in preoperative visit, individualized nursing plan, and the provision of surgical information to alleviate the patient's anxiety; close monitoring during operative care to avoid surgical injury; and medication, breathing regulation, and attention shift to relief the patient's pain. During the postoperative period, the patient was trained in lower limb joint rehabilitation to regain motility. Available social resources near the patient's residency were provided at the time of discharge to assist the patient in home care and the recovery of the patient to the original lifestyle.