一位小兒麻痺患者行全髖關節置換術之手術全期護理經驗

Perioperative Nursing Experience of a Patient with Poliomyelitis Undergoing Total Hip Replacement Surgery

本文為一位小兒麻痺個案,因髖關節發展性發育不全合併退化性關節炎,接受全髖關節置換術之手術全期護理經驗。照護期間2014年9月3日至2014年9月11日,以手術全期照護模式為基礎,藉由傾聽、溝通技巧及觀察收集資料,確立個案有焦慮、體溫過低、急性疼痛及身體活動功障礙護理問題。護理過程中,提供個案手術相關訊息,增加個案對手術的認知,改善個案焦慮不安情緒,有信心的接受手術;使用回溫護理措施,提升體溫,有效縮短個案寒顫不適時間,改善個案低體溫問題;術後依個案疼痛指數,依醫囑給予硬脊膜外腔個案自控式止痛(PCEA),並教導個案緩慢深呼吸、按摩,減緩疼痛;協助個案漸進式進行肢體復健運動,教導出院後日常生活個案正確姿勢的維持,使個案儘快恢復以往之生活。

This article describes the perioperative nursing experience for a poliomyelitis patient with dysplasia of the hip complicated osteoarthritis receiving total hip replacement surgery. The nursing period was from September 3rd, 2014 to September 11th, 2014. These data were collected by listening, communication, and observation. Perioperative nursing care was used for a holistic frame to assess and formulate nursing problems and the patient’s needs. The patient’s health problems included anxiety, hypothermia, acute pain, and impaired physical mobility. During the nursing process, provision of surgery information enhanced the patient’s awareness of the surgical procedures, reduced anxiety and increased confidence in the operation. Rewarming procedures were used for hypothermia to shorten the duration of shivering. Following the operation, we evaluated the patient’s pain score, which was controlled by the Patient-Controlled Epidural Analgesia, and we taught the patient slow deep breathing and massage. Physical rehabilitation was provided to maintain the correct postures for daily life and facilitate daily activities.