照護一位青少年下肢創傷合併腓神經受損個案之護理經驗

A Nursing Care Experience for an Adolescent with Femoral Neuropathy in the Lower Limb

本文是描述一位16歲，正值青少年的個案，因車禍導致左下肢創傷合併腓神經受損造成肢體障礙。照護期間為2014年6月30日至2014年7月9日，筆者經由直接護理、會談、傾聽、查閱病歷等方式收集資料，以Gordon十一項功能性健康模式作整體性評估，確認個案的主要健康問題有急性疼痛、組織完整性受損、身體活動障礙及身體心像紊亂等健康問題。藉由聆聽音樂、觀賞花田少年史來轉移對疼痛的注意力；教導營養食物之攝取、遵守無菌換藥原則及傷口自我照護等來促進組織復原；執行復健計畫及製作肢體運動拉帶來訓練腿部肌肉力量，預防肌肉萎縮，逐漸恢復身體的活動功能；並運用電玩遊戲，增加個案自信與成就感，面對疾病所帶來的身心改變。同時介紹病友藉由同儕之間的互動及彼此分享疾病調適，幫助建立良性的人際互動與正向的社會發展，來重拾自我價值。

This article discussed a 16 year old adolescent with femoral neuropathy in the lower limb caused by a motor vehicle accident. During the nursing period from June 30th, 2013 to July 9th, 2013, the author collected data through direct care observations, interviews, listening, and patient chart review. The Gordon's 11 items health function was used to assess the patient and it was determined that the patient was prone to acute pain, impaired tissue integrity, disturbance of body movement, and disturbed body image. The patient was provided with therapeutic activities, such as listening to music and watching a Japanese manga, Hanada Shonen Shi, to mitigate his attention on pain. He was given directions to increase intake of healthy high-nutrient dense foods, to comply with principles of aseptic technique in wound dressing, as well as wound self-care to promote wound healing. In addition, discussion with the physical therapist was conducted to plan for rehabilitation and to exercise legs using resistance bands to improve his daily activity and functions. Additional therapeutic activities such as video games were utilized to increase his confidence and self-fulfillment. Moreover, support group for disabled was also provided to help him overcome mental disorder and to cope with body image changes.