一位脊髓完全性損傷病人在加護病房之護理經驗

Nursing experience of a patient with complete spinal cord injury in ICU

本文探討一位脊髓損傷合併四肢癱瘓之加護病房照護經驗。個案因不慎高處跌落，造成第4至7頸椎壓迫性損傷，影響肩和頸部以下運動感覺功能受損，導致身體功能喪失，個案無法接受四肢癱瘓的事實，產生想要放棄自己之無望感，引起筆者想協助個案減輕身心理不適與因應接受疾病的動機。護理期間為2018年11月10日至11月16日，筆者以觀察、會談、病歷查閱，應用Gordon十一項功能性健康型態進行評估，發現個案有急性疼痛、身體活動功能障礙、無望感等三項健康問題。筆者針對健康問題，提供個案舒適臥位、肌肉放鬆技巧及轉移注意力等多元化護理措施，頸部與傷口疼痛指數由8分降至0分；損傷早期與復健師討論擬定復健計畫，提供整體性、個別性需求之照護，協助肢體恢復到最大功能，經由主動協助全關節運動及日常生活訓練，上下肢肌力由0分各提升至2分及1分。透過關懷及陪伴個案，適時給予鼓勵及稱讚，與家屬建立連結關係，提供全人的照護，讓個案從無望到逐漸接受現況。建議不僅可以在急性期進行身心照護，與建立以家庭為中心的照護，可教導家庭成員學習相關照護知識與技巧，協助個案重建自我與調適生活。

This article described the nursing experience of a patient with spinal cord injury and quadriplegia in an intensive care unit. The patient fell from a height accidentally and led to 4th to 7th cervical spine compression injury, which caused physical disability as a result of motor and sensory dysfunction below shoulder and neck. Due to quadriplegia, the patient's emotion turned to depression and wanted to give up his life. As members of the medical team, we tried to help him accept the truth of his situation and cope with depression. From November 10th to 16th, 2018, we identified that he suffered from acute pain, hopelessness and impaired physical mobility by Gordon´s 11 Functional Health Patterns, through observation of clinical symptoms, interview and review of the chart. We provided various care measures such as comfortable positioning, muscle relaxation techniques, diversion of attention and other ways of nursing care, VAS score of neck pain decreased from 8 points to 0 point. We made optimal planning to early rehabilitation for spinal injury patient by discussing with physical therapist. We created an individualized and comprehensive rehabilitative protocol and recovered the patient's physical functions as best he could. By passive ROM rehabilitation and daily training of active ROM, muscle power of 4 limbs elevated from 0 point to 2 points. Comprehensive cares, connection with family members and encouraging the patient made him comeback from the emotion of hopelessness. Not only the cares of physical and psychological problems at acute stage, but also it is suggested that we can educate the patient's family members to learn the knowledge and techniques of family-based care and help the patient to rebuild a new live together.