一位股骨頭壞死行髖關節置換術患者之手術全期護理經驗

The Nursing Experience of a Patient with Osteonecrosis of Femoral Head Undergoing a Total Hip Replacement Surgery

本文在探討一位因股骨頭缺血性壞死行髖關節置換術病人之手術全期的護理經驗。護理期間為2011年12月19日至2011年12月26日，筆者藉由觀察、病歷查閱、術前及術後會談訪視收集資料，以Gordon十一項健康功能型態評估，歸納出個案的健康問題有：焦慮／與面對手術及手術結果未知有關、潛在危險性手術情境的傷害／與手術、麻醉、環境因素有關、急性疼痛／與手術傷口造成組織損傷有關、知識缺失／與術後自我照顧有關。在照護過程中，筆者評估個案需求，適時的給予心理支持，針對問題擬訂護理計畫，提供髖關節置換術資訊及教導預防髖關節脫臼之護理措施，有效降低個案對手術的焦慮、術中未發生異常問題、減輕了術後疼痛及增加個案對手術的相關知識，提昇自我照顧能力，使之回歸正常生活。期盼此個案之照護經驗分享，能提升髖關節置換術病人之手術全期護理品質。

This article was to discuss the nursing experience of a patient with osteonecrosis of femoral head undergoing a total hip replacement surgery being nursed during 19th to the 26th of December 2011. We collect the data via observation, studying charts, preoperative and postoperative consultation; assess health problems based on Gordon's 11 Functional Health Patterns Assessment. The main health problems of this patient were as follows: (1) Anxiety/ related to facing the procedure and the uncertain outcome. (2) The potential hazard of the risky procedure/ related to the surgery, anesthesia, and environmental factors. (3) Acute pain / related to the surgical tissue injury. (4) Lack of knowledge/ related to the postoperative self care. During the course of nursing, we assess the needs of patient, timely offer psychological support, draw up nursing care plan according to the patient’s conditions, and provide information about total hip replacement surgery and education for artificial hip joint dislocation prevention; effectively lower patient’s anxiety about the surgery. There was no peri-operative unexpected event, which abate the postoperative pain and increase knowledge about the surgery. Most important was to motive patients’ ability of self care and back to his daily life. We hope that sharing of the experience of nursing this patient can improve the quality of nursing care of a patient who underwent total hip replacement surgery.