一位麻醉護理師照護腰椎間盤切除術患者之手術全期護理經驗

A Nurse Anesthetist's Perioperative Nursing Care Experience of a Patient Undergoing Lumbar Discectomy

本文是描述一位36歲男性腰椎間盤破裂且突出接受腰椎間盤切除術之手術全期護理。作者為一位麻醉護理師，護理期間自2016年9月12日至15日，筆者以Gordon十一項健康功能評估，運用觀察、會談、病歷資料查閱及身體評估等方法收集資料，並分析歸納出病人的健康問題有「急性疼痛」、「焦慮」、「知識缺失」及「潛在危險性手術情境的傷害」。針對以上問題，筆者在手術前、後運用多媒體影音進行衛教，包括手術前準備事項、全身麻醉的介紹、手術過程、疼痛的處理、居家自我照護注意事項及維持腰背部平直的正確姿勢，以降低面對全身麻醉及手術未知結果如癱瘓等後遺症的焦慮；術後與病房主責護理人員共同照護，使用藥物及非藥物的護理措施，透過按摩耳穴和案女視訊來轉移對急性疼痛的注意力，教導強化背部及腹部肌肉的運動，提升病人的自我照顧能力，預防疾病的再發生，以達到最佳的健康狀況；手術中病人採全身麻醉，給予完全代償性護理措施，提供功能性俯臥姿勢避免神經肌肉損傷，且使用生理食鹽水袋充填850 cc的水量自製水枕，依病人的臉形自動塑形後調整支撐力，預防臉部壓傷。期望藉此護理經驗之分享，提供日後照護類似病人的參考。

This article describes a perioperative nursing care experience for a 36-year-old male with ruptured disc who had lumbar discectomy. The first author is a nurse anesthetist who took care of the patient from September 12 to 15, 2016. Gordon's 11 functional health patterns were applied to assess the patient's health problems. Data were collected by using observations, interviews, patient's documentation and physical assessment. Consequently, 'acute pain', 'anxiety', 'deficient knowledge' and 'risk for perioperative-positioning injury' were identified as the patient's nursing problems. The first author used multimedia audio and video to teach the patient before surgery, including pre-operative preparation, introducing general anesthesia, surgery procedures, pain management, self-care tips, and how to keep appropriate posture after surgery to reduce the anxiety of general anesthesia and uncertainty perceptions from surgery. After the surgery had done, in order to improve the patient's self-care ability and prevent recurrence of the disease to achieve health status, the first author took care the patient with his primary nurse, not only provided medications and non-pharmacological nursing interventions, but also applied massaging ear acupuncture point and video communication with the patient's daughter to draw attention from pain, and taught the patient how to strengthen the back and abdominal muscles. The patient underwent general anesthesia during surgery, giving complete compensatory care and providing functional prone position to avoid neuromuscular injury. In order to prevent facial pressure injury, the author also used normal saline bag to fill 850 c.c. water to become a water pillow. It is hoped that the caring experience will provide a reference for the similar case in the future.