照顧一位退化性關節炎病患接受膝關節置換手術之經驗

The Nursing Care Experience of a Knee Osteoarthritis Patient with Total Knee Replacement

膝關節為人體下肢中一個重要的關節，不論站立或活動均須靠它，因此膝關節容易因過度負重而產生退化病變與疼痛等問題，嚴重的關節病變及疼痛時常需接受關節置換術來改善生活品質，其中老年人是關節重建的最大族群。本文是探討一位65歲女性病患因右膝退化性關節炎需接受膝關節置換術的護理經驗。護理期間自2010年7月26日至8月3日，筆者運用Gordon十一項功能健康型態進行整體性評估，發現個案主要健康問題有焦慮、急性疼痛、身體活動功能障礙及知識缺失四項健康問題。藉由溝通會談、傾聽個案感受，建立良好互信的護病關係，針對個案的護理問題提供整體性護理措施，包括採取持續性的關懷支持並引導說出內心感受，運用放鬆技巧、介紹成功案例來協助減輕個案焦慮；疼痛方面，應用疼痛緩解處置，減輕其術後引起的生理不適感；與個案討論復健運動進度，依計畫採漸進式的下床活動，促進肌肉關節的活動度，改善活動功能障礙，進而提升生活品質。期望此護理經驗對日後照護此類患者之護理同仁的臨床能力有所助益。

Knee osteoarthritis, a leading cause of disability with incidence and prevalence rising in most elderly populations, is a progressive degenerative disease. Patients with severe knee osteoarthritis usually need to be treated by total knee replacement. This article described our nursing experience of caring a 65 years old female knee osteoarthritis patient with total knee replacement in her right knee from July 26 to August 3 in 2010. The author evaluated her health problems by Gordon’s 11-item functional health pattern and found her problems combined with anxiety, acute pain, impaired physical function and knowledge deficit. In the period of nursing care, the author constructed great nurse-patient relationship by communication and listening. According to her problems, we rendered complete measures to lessen her anxiety that included continuing concerns and supports, utilization of relaxing skills, and introduction of successful case evidences. In addition, we also provided pain control equipment to lessen her postoperative discomforts and introduced a series of rehabilitated activities to enhance her joint’s activity and quality of life. We hope that our experience can provide nursing staff with a reference to care the patients receiving total knee replacement.