一位脊椎腫瘤個案放置導尿管之居家護理經驗

Home Care Experience for a Client with the Spinal Tumor and Urinary Catheter

本篇旨在描述一位45歲脊椎腫瘤術後個案，因放置導尿管，長期坐或臥床造成肢體關節僵硬居家照護經驗。護理期間為2013年10月13日至12月27日，筆者運用Gordon十一項健康功能型態為評估架構，經由直接照顧、觀察、會談等技巧收集資料，發現個案有：（一）現存性感染；（二）身體活動功能障礙；（三）家庭因應能力準備度等健康問題。藉由指導擠壓尿管、每天服用蔓越莓錠、使用體溫紀錄單記錄體溫，使個案泌尿道感染改善；指導外傭上下床移位及復健運動，增加個案的肌力及活動範圍，個案已能以單手柺杖由臥房行走到客廳；引導及鼓勵個案及案夫表達內心感受與期待。居家護理師擔任情緒支持者，協助運用長期照護資源等措施介入後，個案照護品質改善並持續予支持及追蹤。建議製作以外籍文為主的照護指導影片，提升外籍照服員照護品質及提升照顧技能。

The purpose of this article was to discuss the caring experience of a 45-year-old subject who　was inserted urinary catheter leading to low activity and progressing rigidity of extremities after spinal cord tumor operation. The period of nursing care was from October 13 to December 27, 2013. Clinical observation, interview and direct care were used guided by Gordon's 11-item health assessment to identify nursing problems. The major nursing problems were catheter related urinary tract infection, physical disability and readiness for enhanced family coping. 'Lower urinary tract symptoms' disappeared by appropriate catheter care, cranberry tablets and daily body temperature records. Moreover, the subject could walk from bedroom to living room with cane by rehabilitation instruction. We also continuously encouraged and supported the subject and her husband to express their feelings and expectations. We recommended making care guide films of foreign language to improve the quality of care skills of foreign caregiver.