一位愛滋病個案行膿瘍引流併頸椎椎板切除術之手術全期護理

A Perioperative Nursing Experience with an AIDS Patient Undergoing Abscess Drainage and Cervical Laminectomy

本文敘述一位靜脈毒癮感染愛滋病個案，因脊髓硬膜上膿瘍合併頸椎退化性病變，住院行膿瘍引流併頸椎椎板切除術的手術全期護理經驗。護理期間自2012年12月24日至2013年1月16日，筆者運用Gordon十一項功能性健康型態模式為評估架構，確立個案有焦慮、現存性感染、無效性健康維護能力等健康問題，筆者針對術前焦慮提供術前衛教與心理支持，使個案能放心接受手術；術中提供高品質的安全防護措施與協助手術進行；術後提供頸椎術後感染控制、自我照顧與復健衛教，協助個案安然渡過手術前、中、後期之各種問題，順利恢復日常生活功能並及早出院。在以病人為中心照護的理念下，手術室護理不再侷限於手術房內，手術室護理師必須走入病房，妥善運用手術室護理的專業知識，提供個案手術前、中、後期的評估與照護，幫助個案解決術前焦慮，安全渡過手術危險期，正確學習術後自我照顧與早期接受復健，以維護手術安全與促進術後復原，提升手術全期之護理品質。

This case report describes perioperative nursing experience with a patient undergoing abscess drainage and laminectomy after being infected with acquired immune deficiency syndrome (AIDS) through drug use by injection and diagnosed with a spinal epidural abscess and cervical spondylosis. The nursing period was from December 24, 2012 to January 16, 2013. Gordon’s Functional Health Patterns were applied to assess the patient’s condition. Three health-related problems were identified: anxiety, existing infection, and ineffective health maintenance. Nursing interventions included providing: preoperative health education and psychological support to reduce the patient’s anxiety, high-quality safety protections and assistance during the operative procedures, and postoperative infection control, self-care, and rehabilitation education. These interventions helped the patient to successfully manage all problems before, during, and after surgery, and to regain functions of daily living, and be discharged from the hospital as soon as possible. To achieve holistic health care, operating room nurses should not be confined to operating rooms, but should enter wards to provide patients with perioperative evaluation and care by applying appropriate professional knowledge. Helping patients overcome preoperative anxiety, pass through the crisis of surgery, learn postoperative self-care, and receive early rehabilitation could maintain patient safety in surgery and promote postoperative recovery, thereby improving the quality of perioperative nursing care.