一位接受雙側全膝關節置換術的獨居長者之護理經驗

The Nursing Care Experience of An Elderly Female Living Alone after Bilateral Total Knee Replacement Surgery

退化性膝關節炎是老年人常見的疾病，其產生疼痛及關節活動限制易造成殘障，嚴重影響病人的生活品質。本文描述一位嚴重退化性膝關節炎的獨居長者接受雙側全膝關節置換術之護理經驗。照護期間2017年5月19日至5月30日，依據歐倫自我照顧理論，透過照護、觀察、會談、病歷資料及身體評估，確認病人有急性疼痛、身體活動功能障礙、自我照顧能力增進的準備度等三項護理問題。擬定個別性護理計畫，以部分代償性護理、支持與教育性護理措施，透過增強病人長久處理關節疼痛經驗，以減輕術後急性疼痛。提供漸進性復健運動的示範跟隨執行，增強復健動機逐漸增加關節動度及肌肉強度。依自我照顧能力的進展，討論返家獨居日常生活的困難，規劃適當自我照顧技能改善方案，在住院期間即模擬試行方案，提升自我照顧技巧重拾其信心，並整合其自我照顧之能力，使病人能完成日常活動順利返家，回歸獨立自主的生活。

Osteoarthritis of the knee is not only a common disease but also one of the major diseases that cause disability in elderly people. The knee pain caused joint limitation of activity seriously affects the quality of life of patients. This article describes the nursing care experience if a single elderly person with severe osteoarthritis of the knee who underwent bilateral total knee arthroplasty. The period of nursing care was from May 19th to 30th, 2017. Based on Orem’s self-caring theory, through direct care, observation, interviews, medical records, and physical assessment, the following health problems were identified: acute pain, physical activity dysfunction, and increased self-care ability. This author developed an individual care plan, with total and partial compensatory nursing, and supportive and educational nursing. The plan aimed to reduce acute pain by enhancing the patient’s long-term experience in handling joint pain, providing demonstrations and follow-up execution of progressive rehabilitation exercises, enhancing rehabilitation motivation, gradually increasing joint mobility and muscle strength, and maintaining physical activity. We used support and encouragement to enhance her rehabilitation motivation and self-confidence. According to the progress of her self-care ability, we discussed with her the difficulties of returning home to face daily life living alone. We then drew up appropriate self-care skills, and simulated and practiced them during hospitalization. Therefore, the patient learned self-care skills and resumed the functions of daily activities in independent life.