位青少年車禍導致骨折接受手術之手術全期護理經驗

Perioperative Nursing Experience of a Teenager Receiving Surgery for Traffic Accident-induced Fracture

本文旨在描述一位青少年車禍導致骨折接受手術之手術全期護理經驗。護理期間自2017年1月20日00:05至03:40。在護理期間及術後回病房追蹤期間以Gordon十一項功能性健康型態為評估工具，發現個案因第一次手術及擔心術後無法從事其喜歡的運動而出現「焦慮」之問題；在手術中期因手術擺位及各種儀器的使用，而有「潛在危險性手術情境的傷害」之問題；因全身麻醉插入氣管內管及手術過程中組織受創，在手術後期出現「急性疼痛」之問題。手術前期，與個案建立良好的護病關係，應用個案可以理解的字眼，輔以圖繪說明，進行手術前衛教，以降低手術的不確定感，進而減輕其焦慮；筆者在手術中期，一起將個案擺放舒適、安全之手術臥位，並於易受壓部位及骨突處予支拖、襯墊，以預防神經、骨骼肌肉及血管系統的傷害，針對個案使用的各種儀器設備，也隨時注意其安全性，以維持其正常體溫、預防皮膚燒傷及輻射傷害；在手術後即刻期，提供緩解疼痛的方法，如教導緩慢深呼吸、翻向健側避免壓迫傷口及按摩。盼藉此護理經驗能提供護理人員作為日後照顧類似病人之參考。

This case report describes perioperative nursing experience of a teenager who received surgery for a traffic accident–induced fracture. The nursing period extended from 00:05 to 03:40 on January 20, 2017. During the nursing period and follow-up after the patient returned to his ward, Gordon's 11 functional health patterns were adopted as the assessment tool. The author identified that the patient was exhibiting anxiety because it was his first time receiving surgery and he was afraid of being unable to engage in his favorite sport afterward. In the intraoperative phase, ''Risk for perioperative–positioning injury'' was identified in terms of surgical positioning and equipment use. In the postoperative phase, the patient exhibited acute pain caused by endotracheal tube insertion under general anesthesia and by tissue injuries incurred during the surgery. In the preoperative phase, the author established a satisfactory nurse–patient relationship with the patient, using vocabulary the patient could understand and supplementary illustrations to explain the situation, providing him preoperative health education to lower his fear of the unknown and alleviate anxiety. In the intraoperative phase, the author, together with the surgeon, placed the patient in a comfortable and safe surgical position and provided support and pads to the patient's apophyses and other body parts susceptible to squeezing to prevent damaging the patient's nerves, bones, muscles, and vascular system. Constant attention was also paid to all devices and equipment used to maintain the patient's body temperature within a normal range and prevent skin burns, broken skin, and radiation damage. In the postoperative phase, the author suggested to the patient methods to mitigate pain, such as deep breathing, turning over to the healthy side to avoid compressing the wound, and massage. The experience can serve as a reference for nursing personnel caring for patients with similar conditions in the future.