照顧一位使用抗人類免疫缺乏病毒藥物導致缺血性股骨頭壞死之護理經驗

Experience of Providing Nursing Care to a Patient with Femoral Head Avascular Necrosis Caused by Antiretroviral Drug Use

本文描述一位29歲男性，長期服用人類免疫缺乏病毒藥物而左髖關節股骨頭缺血性壞死，因疼痛影響日常活動功能及性生活次數，情緒充滿焦慮不安，引發筆者撰寫之動機。護理期間2020年10月25日至10月29日，照護期間與個案建立友好的護病關係，運用觀察、會談、傾聽、查閱病歷等方式收集資料，以Gordon十一項功能性健康模式做整體性評估，歸納出主要健康問題有急性疼痛、身體活動功能障礙、焦慮等，筆者提供藥物及非藥物方式來緩解急性疼痛，與醫療團隊共同擬定復健指導計畫，協助個案參與肢體復健運動，示範助行器輔具使用及行走方式，並鼓勵男性伴侶給予陪伴與正向支持；個案擔心術後日常活動受到限制，也影響性生活而引發焦慮問題，藉由傾聽個案心理感受，教導放鬆技巧、轉移注意力緩解焦慮；鼓勵男性伴侶參與計畫、提供髖關節術後性姿勢的圖文解說，並且傾聽雙方的想法與觀念達到共識。建議未來在職教育訓練能多舉辦相關性諮商的課程，讓護理人員接觸類似個案此健康問題時，亦能提供更完整的資訊。期望藉此護理經驗之分享，提供照顧類似個案的參考，以提升照護品質。

This study describes the nursing care experience of a 29-year-old male HIV patient who developed avascular necrosis of the femoral head in the left hip joint, secondary to long-term antiretroviral therapy. The patient’s exacerbated pain significantly impacted his daily activities and sexual life, resulting in anxiety and fear of being unable to meet his partner’s sexual needs. During the care period from October 25 to October 29, 2020, the researcher established a therapeutic relationship with the patient and collected data through observation, interviews, and review of medical records. Using Gordon’s 11 Functional Health Patterns for comprehensive assessment, the patient’s primary health problems were identified as acute pain, physical and functional impairment, and anxiety. In addition to standard post-hip surgery care, attention was given to the patient’s sexual health, an often-overlooked aspect of nursing care. Interventions focused on pain management, functional support, and psychological counseling to address anxiety and concerns related to sexual activity. This case highlights the importance of holistic, patientcentered nursing care that addresses both physical and psychosocial needs, including sexual health, in patients with chronic conditions and HIV-related complications. The author recommends incorporating sexual health consultation into in-service training programs for nurses to enhance comprehensive care. This experience may serve as a reference for clinical nurses managing patients with similar health problems.