照護一位退化性關節炎行全膝關節置換術病人之護理經驗

A Nursing Experience in a Patient with Osteoarthritis Received Total Knee Replacement

本文為照顧一位因左膝抽痛持續兩週，診斷左膝退化性關節炎，入院行全膝關節置換術之個案照護經驗。照護期間自2020年6月30日至2020年7月7日，個案因對手術不了解而感到焦慮，術後因疼痛不敢動，且擔心返家後自我照護問題，引發筆者探討動機，經Gordon十一項功能性健康型態評估後，擬定焦慮、急性疼痛、身體活動功能障礙、增進健康準備度等四項健康問題之護理計畫，以圖示及多媒體影片輔助說明手術前後護理、教導止痛技巧、安排下肢復健計畫、教導傷口換藥及居家照護等措施，達到緩解個案焦慮與傷口疼痛，增進個案的復健訓練與居家照顧知能之目標，建議未來可建置並登錄資訊化出院照管系統，以利追蹤TKA術後病人出院復健與自我照護狀況，亦可作為醫療照護諮詢管道。希望藉由此護理經驗分享，提供護理人員在照護全膝關節置換術之退化性膝關節炎病人及其主要照顧者護理指導之參考。

This article describes the nursing experience of a patient with the left knee osteoarthritis who experienced, throbbing pain that last for two weeks, therefor admitted for total knee replacement. During nursing care from June 30 to July 7, 2020, the patient who felt anxiety caused by incomprehension about surgery procedure, and was unwilling to activity due to wound pain, and worried about self-care after discharge. We confirmed anxiety, acute pain, decreased physical activity, and readiness for enhanced knowledge by using the Gordon's Eleven Functional Health Patterns Assessment. Moreover, we executed the nursing plans, which included explaining the procedure before and after surgery aided by illustration or multimedia, pain coping strategies, arranging rehabilitation program, teaching wound care skill and self-care knowledge, to improve the patient’s anxiety, acute pain, and promote his competencies in rehabilitation training and selfcare. In the future, developing a discharg e management information system, to recording and follow up the effects of patients' rehabilited state and self-care ability with total knee replacement, the system also can be one of a method in nursing consultation. The author hope this nursin g experience could serve as a useful reference to the clinical nursing care guidelines for knee osteoarthritis patients receiving total kne e replacement operation and also for the main caregivers.