照護一位腰椎手術後併發脊髓硬膜外血腫個案之護理經驗

The Nursing Experience of a Patient After Lumbar Surgery Complicated with Spinal Epidural Hematoma

本文旨在描述一位因腰椎間盤狹窄接受腰椎手術，術後發生脊髓硬膜外血腫，所造成的生理及心理衝擊之護理經驗。護理期間自2018年11月6日至2018年12月23日。照護期間運用Gordon十一項健康功能型態為評估架構，確立個案有：「急性疼痛」、「身體活動功能障礙」及「焦慮」之健康問題。在照護期間，提供對疼痛的轉移注意力、避免傷口壓迫、傷口護理以促進傷口癒合、定時評估疼痛之緩解／增強因子（provocative／palliative, P）、性質／程度（quality／quantity, Q）、部位／輻射部位（region／radiation, R）、嚴重度（severity, S）、時間（timing, T）（PQRST），並適時給予止痛劑使用，以緩解疼痛；個案因腰薦椎神經根損傷而導致下肢肌肉強度降低，筆者首先增加個案的疾病認知及對執行復健計畫的動機，之後協助執行下肢全關節運動、肌肉等長收縮運動及使用輔具維持功能性擺位，以避免關節攣縮、肌肉萎縮及增加肌肉強度；個案因下肢無力、失能，而感到焦慮，筆者以主動關懷、同理心來了解個案心中的感受及擔憂事件，之後根據個案之個別性提供相關資訊並協助個案與醫療團隊溝通，以瞭解治療計畫及疾病預後，在復健過程中，當個案有良好進展時，給予正向鼓勵。盼藉此經驗能提供護理人員作為日後在照顧類似病患之參考。

This case report describes the nursing experience of a patient suffer from spinal epidural hematoma after lumbar spinal surgery for lumbar spinal disc stenosis, who dealt with physical symptom and psychological impact. The nursing period was from November 6, 2018 to December 23, 2018, according to the data analyzed by the assessment tool of Gordon 11 Functional Health Patterns, the result indicated that the patient's nursing problem including acute pain, impaired physical mobility, and anxiety. During the period of caring, the author provided the patient's pain relief methods, such as distracting attention from pain, avoiding wound being pressed, affording wound care to promote wound healing, assessing provocative/palliative (P), quality/quantity (Q), region/radiation (R), severity (S), and timing (T) for pain (PQRST), and timely administering analgesics. The patient's lower extremity muscle strength is reduced due to lumbar nerve root damage. The author first increased the patient's disease knowledge and motivation to implement the rehabilitation plan, and then provided measures to avoid joint contracture, muscle atrophy and increase muscle strength, such as assisting range of motions for the lower extremity , performing isometric exercise of muscle, using assistive device to maintain functional positioning. The patient had anxiety due to weakness of the lower limbs and disability. The author applied caring and empathy to understand the patient's feelings and concerns, and then providing individual information and assisting the patient to communicate with the medical team to understand the treatment plan and the prognosis of the disease, and during the rehabilitation process, positive encouragement is given when the patient has made good progress. The findings are helpful to serve a reference to other nurses care of similar patient.