照顧一位脊髓損傷導致下肢癱瘓患者術後護理經驗

Nursing Experience of Postoperative Care for a Patient with Lower Limb Paralysis Caused by Spinal Cord Injury

本文描述照護一位65歲男性因由高處跌落造成第三至七頸椎損傷導致下肢癱瘓，接受外科手術治療，面對術後傷口疼痛及神經肌肉損傷造成肢體障礙失去控制感之衝擊，而產生無望感之護理經驗。於護理期間2020年1月4日至2020年2月4日，以觀察、會談、身體評估及直接照護方式收集資料，運用Gordon十一項功能性健康型態進行整體性評估，考量篇幅依照護需求的優先順序，故僅針對探討急性疼痛、身體活動功能障礙及無望感三項護理問題進行探討。在護理過程中，透過協助舒適擺位、教導按摩放鬆及音樂療法轉移注意力，且配合止痛藥物使用，緩解個案疼痛感；共同擬定復健計劃，提供關節運動與肌力訓練，以增進肢體活動力，進而改善身體活動功能障礙；採取主動關懷，傾聽，鼓勵表達內心感受，引導個案能正向思考，及鼓勵積極參與自我照護與訓練，增強正向信心，改善其無望感，使個案重新適應生活。建議在照顧此類患者時，可以運用多媒體工具，強化正確照護知識以增加自我照護之能力，主動提供出院準備服務，並配合個管師後續追蹤，提供完善的整體性照護。

This article describes a nursing experience caring for a 65-year-old male with lower extremity paralysis due to third to seven cervical vertebrae injury caused by fall from height, who received surgical treatment and faced by the sense of hopelessness brought by the impact of postoperative wound pain and neuromuscular injury that led to physical disability and loss of control. The period of care was from January 4 to February 4, 2020. Data were collected through observation, interviews, physical assessment and direct care. Gordon's 11 functional health patterns were applied for overall assessment. However, considering the length of the article and the priority of nursing needs, only three nursing problems, including acute pain, physical dysfunction and sense of hopelessness were explored. In the nursing process, assistance in comfortable positioning and instruction of relaxing massage and music therapy for attention diversion were provided, and analgesic drugs were also used to relieve the pain. A rehabilitation plan providing joint exercises and muscular strength training was jointly developed to improve the patient’s physical activity that further improved physical dysfunction. Initiatives were taken to care for, listen to, and encourage the patient to actively participate in self-care and training to enhance his positive confidence and improve the sense of hopelessness, enabling the patient to re-adapt to life. It is recommended that when taking care of such patients, multimedia tools can be used to strengthen correct knowledge of care to improve their capabilities of self-care, actively provide discharge preparation services, and cooperate with the case manager for follow-ups so as to provide complete holistic care.