照顧一位肱骨骨折接受多次手術兒童的護理經驗

Nursing Experience of a Child Diagnosed with Humerus Fracture Who Received Multiple Operations

10.6142/VGHN.28.2.164

李庭芳(Ting-Fang Li)；林麗華(Li-Hwa Lin)；王金蓮(Jin-Lian Wang)

肱骨骨折 ； 兒童 ； 多次手術 ； humerus fracture ； multiple operations

榮總護理

28卷2期（2011 / 06 / 01）

164 - 171

繁體中文

本文係探討一位5歲學齡前期幼童，因意外跌落導致左手肱骨髁上骨折而行開放性復位手術，出院後又因鋼線移位及傷口癒合不良而再度入院治療之護理過程。在護理個案期間，應用Gordon十一項健康型態模式，進行個案整體評估，確立其健康照護問題有恐懼、高危險性感染、生理舒適情況改變－疼痛、身體活動功能障礙等問題。藉由角色扮演與個案建立信任感及良好護病關係，協助兒童表達內心恐懼害怕的事情，使其願意接受治療；術後給予傷口照護，預防再度發生感染；同時以藥物、擁抱及鼓勵，安撫個案的情緒，緩解病人的疼痛；並以故事引導及遊戲方式，使個案學會復健運動且融入於生活計畫中。照護一位承受三次住院手術經驗的學齡前期幼童，在童言童語與有限的認知下，如何探索小小的內心世界，護理功能顯得非常重要，亦實為極大的挑戰，故分享此次的護理經驗提供臨床照護之參考。

This case report examined a nursing care process upon a five-year-old child diagnosed with humerus fracture, who was admitted for wire migration with poor healing wound. Gordon's eleven functional health patterns were applied to physical, psychological, social and developmental evaluations. Health problems were identified as anxiety, infection, impaired physical comfort and pain, and impaired physical mobility. Role play method was utilized to build up trust, express feelings of fear, and accept interventions. In the mean time, medications, hugs, and encouragement were synergized to overcome emotional tension. Rehabilitation exercises were integrated into daily activities through games and storytelling. Giving the limited speech and cognitive function, exploring the child's inner world and implementing nursing care have been challenges to the process.