護一位腰椎爆裂性骨折病人之護理經驗

The Nursing Experience of a Patient with Spinal Burst Fracture

本文係探討因腰椎爆裂性骨折入院接受腰椎手術之護理經驗。護理期間自2015年9月1日至9月13日。入院時見個案情緒低落，不時疼痛哭泣，且尾骶骨有3級壓瘡，引發撰寫動機。筆者藉由觀察、傾聽、會談及身體評估蒐集主客觀資料，並以Gordon十一項健康功能型態進行整體性評估，確立個案主要健康問題：急性疼痛、排尿型態障礙、焦慮、皮膚完整性受損及無效性健康維護能力。筆者感受到個案面對疼痛的無助和對手術的不安，透過照護過程與個案建立信任關係，適時予情緒安撫，協助緩解急性疼痛，鼓勵說出對於手術的期待和疑問，提供正確的手術相關資訊，減輕對手術之焦慮，並會診營養師及傷造師評估及執行壓瘡照護。在醫療團隊協助下，個案及家屬學習移位及傷口照護等技巧，同時轉介社區衛生所後續復健事宜。藉由此次照護經驗，感受脊椎骨折病人復健是漫長的，建議在進行病人出院準備計畫時可提供急性後期的復健轉介，如社區衛生所所提供之復健服務等。

This article describes the nursing experience of a patient undergoing surgery because of lumbar burst fracture. She came to hospital with 3 pressure scores of coccyx, and appeared upset and cried sometimes. During the nursing period (Sep/1/2015 to Sep/13/2015), 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 acute pain, impaired urinary elimination, anxiety, impaired skin integrity, and ineffective health maintenance. We established the trusting relationship, helped her to relieve acute pain, encouraged her to say the questions and expectations of surgery, and provided the correct information about surgery to reduce her worry before surgery. In addition, we consulted dieticians and wounding of nurse about evaluation and implementation of pressure sores care. The medical team taught the woman and her family skills such as shift and wound care, and at the same time referred her to community health center having physiotherapy. With this experience of care, suggestions to provide the post-acute care referral when we did patient preparation plan before leaving hospital, such as physiotherapy services were provided by community health center.