一位脊椎滑脫術後併發右眼失明患者之護理經驗

Nursing Experience of Losing Right Eye after Spondylolisthesis Surgery

脊椎是支撐人身體軀幹的重要構造，而脊椎滑脫是骨科常見的疾病之一。本文主要探討一位68歲男性因腰椎第四、五節滑脫接受脊椎固定手術，術後併發右眼失明的個案，在面對非預期性併發症的心理衝擊過程。筆者於2009年12月2日至12月20日照護期間，經由觀察、會談、身體評估、查閱病歷等技巧收集資料，確立個案住院期間主要健康問題包含睡眠型態紊亂、無力感及潛在危險性跌倒，除運用專業及適切的護理過程，協助緩解個案因手術後併發症產生擔憂、視覺改變與右眼失明所引起之不適，並以各項措施改善睡眠，提供持續性陪伴關懷、傾聽及同理心等鼓勵個案說出內心感受克服視覺改變所帶來之無力感，協助瞭解環境安全之佈置與改變，以增強其信心，預防因失明形成之潛在危險性跌倒所帶來的心理衝擊及伴隨之健康問題。期望藉此護理經驗之分享，能提供護理人員於未來臨床照護病患時，除重視患者生、心理需求外，更應隨時注意病程變化，給予正確完整的身體評估，進而協助醫療團隊及早發現術後潛在問題及異常徵象，以降低併發症對個案之傷害。

Spondylolisthesis is a common disease seen in orthopedics. This article discussed a 68-year-old male with complication of right eye blindness after lumbar fourth and fifth spondylolisthesis undergone spinal fixation. During the care from December 2 to December 20, 2009, the data collection was through observation, interview, physical assessment, and chart review. The author established the major health problems including sleep disturbance, powerlessness, and the risk of falls. In addition to professional and appropriate use of nursing process to ease patient's physical discomfort caused by surgery, listening and empathy techniques such as encouraging express feelings, enhancing confidence and helping to adapt to complications brought about by the psychological impact and the associated health problems were used as well. It is hoped through this case report to share special experiences and to pay attention to patient掇 psychological and physical needs, to be alert to patient's condition change, to give correct and complete physical assessment in order to provide clinical care as well as to reduce the complications of patient injury in the future.