一位高位頸椎損傷學齡期病童之護理經驗

The Experience of Nursing a School-Aged Child with High Level Spinal Cord Injury

高位頸椎損傷係指第四頸椎以上之脊椎損傷，會導致患者呼吸功能衰竭與運動感覺功能的喪失，除了急性期醫療處置外，這種創傷亦需要長期復健及心理支持。本文旨在探討一位高位頸椎損傷學齡期病童，在住進加護病房後，因頸部以下全身癱瘓，及陌生環境造成之種種護理問題。筆者在照護病童的38天過程中，運用Gordon 11項健康功能評估及家庭評估方式，確立護理問題有低效性呼吸型態、活動功能障礙、心理恐懼、睡眠型態紊亂及身體心像紊亂等五項。並根據各項問題提出個別性之護理措施。病童在加護病房期間，因全身癱瘓而無法使用護士呼叫鈴，又因她有氣管內管而不能發聲求助，而出現恐懼、無助之行為。筆者特別設計可由嘴唇控制之呼叫鈴，增加病童安全感。又將可用的醫療資源，包括：護理人員、醫師、呼吸、復健治療師與臨床教師結合一起，共同努力改善病童的呼吸型態、預防肢體萎縮，以提昇病童的自我價值感。在整個護理過程中，透過提供病童身心的照護，使病童在生理及社會方面得到良好的調適。筆者因而對這類病童之行為反應有更深入的了解。撰文發表，旨在提供護理同仁日後照護這類病童之參考。

The "High Level Spinal Cord Injury" means the 4th spinal cord or above is injured. It would cause the patient's exhaustion on breath and limitation of movement. These patients require not only medical treatment but also need the physiological recovery and psychological support in a long period. The purpose of this paper is to analyze the physiological and psychological reactions of a school-aged girl who became paralyzed and had stayed in PICU (Pediatric Intensive Care Unit) because of high level spinal injury. During the 38 days of nursing, we evaluated the following 11 healthy statements such as insufficient breath, limitation of movement, disordered sleep and mind, fear and so on-to propose the corresponding measures of nursing. To mitigate the patient's fear and increase both her sense of security and quality of sleep, we designed a calling ringer for her with the cooperation of public service and clinical teachers. Besides, we also cooperated with other nurses, doctors, and physical therapists to improve the patient's ability of breath and prevent her limbs from atrophy. By this nursing process, we have deeply understood the correlation of the patient's behavior and her psychogenic reaction. It will be a reference for us to improve the effect in nursing this kind of patients in the future.