Application of Orem's Self-Care Deficit Nursing Theory in the Nursing Care of a Patient With Postoperative Paraplegia Following Lumbar Disc Herniation Surgery: A Case Report

Öz

Postoperative paraplegia is a rare but devastating complication of lumbar disc herniation surgery that often results in long-term functional dependence and complex nursing care needs. This case report describes the application of Orem's Self-Care Deficit Nursing Theory in the nursing care of a 45-year-old man who developed permanent paraplegia following lumbar disc herniation surgery despite revision surgery. The patient's clinical condition was further complicated by an advanced infected sacral pressure injury, malnutrition, hypoalbuminemia, previous gastrointestinal bleeding, and polyneuropathy, resulting in extensive self-care deficits. Nursing care was systematically planned according to Orem's theoretical framework by assessing the patient's self-care agency, therapeutic self-care demands, self-care deficits, and appropriate nursing systems. Four individualized nursing care plans were developed by integrating Orem's Self-Care Deficit Nursing Theory with NANDA International (NANDA-I) nursing diagnoses, the Nursing Interventions Classification (NIC), and the Nursing Outcomes Classification (NOC). Nursing interventions focused on pressure injury management, mobility support, promotion of self-care activities, nutritional management, patient and family education, and rehabilitation. During follow-up, no additional pressure injuries, contractures, infections, or recurrent gastrointestinal bleeding were observed. The patient actively participated in rehabilitation within his functional capacity, while family caregivers supported the continuity of care as dependent-care agents. This case demonstrates that Orem's Self-Care Deficit Nursing Theory provides a practical and systematic framework for individualized nursing care in patients with complex postoperative neurological complications. Integrating theory-based nursing care with standardized nursing languages may facilitate clinical decision-making, promote self-care agency, and support rehabilitation outcomes in similar patients.

Anahtar Kelimeler

• Case reports
• Lumbar disc herniation
• Nursing care
• Orem's self-care deficit nursing theory
• Paraplegia.

Destekleyen Kurum

None

Proje Numarası

None

Etik Beyan

This study was conducted as a case report. Written informed consent for publication was obtained from the patient prior to the preparation of this manuscript.

Teşekkür

The authors sincerely thank the patient for providing written informed consent for publication and for allowing this case to be shared for educational and scientific purposes.

Lomber Disk Hernisi Cerrahisi Sonrası Gelişen Postoperatif Paraplejili Bir Hastanın Hemşirelik Bakımında Orem'in Öz Bakım Eksikliği Kuramının Uygulanması: Olgu Sunumu

Öz

Lomber disk hernisi cerrahisi sonrasında gelişen postoperatif parapleji, uzun süreli fonksiyonel bağımlılık ve karmaşık hemşirelik bakım gereksinimlerine yol açabilen nadir ancak yıkıcı bir komplikasyondur. Bu olgu sunumunda, revizyon cerrahisine rağmen kalıcı parapleji gelişen 45 yaşındaki bir hastanın hemşirelik bakımı Orem'in Öz Bakım Eksikliği Kuramı doğrultusunda sunulmuştur. Hastanın klinik tablosu ileri evre enfekte sakral basınç yarası, malnütrisyon, hipoalbuminemi, geçirilmiş gastrointestinal sistem kanaması ve polinöropati ile komplike olmuş, buna bağlı olarak çok yönlü öz bakım eksiklikleri gelişmiştir. Hemşirelik bakımı, hastanın öz bakım gücü, terapötik öz bakım gereksinimleri, öz bakım eksiklikleri ve uygun hemşirelik sistemleri değerlendirilerek Orem'in kuramsal yaklaşımı doğrultusunda sistematik olarak planlanmıştır. Orem'in Öz Bakım Eksikliği Kuramı; NANDA International (NANDA-I) hemşirelik tanıları, Nursing Interventions Classification (NIC) ve Nursing Outcomes Classification (NOC) ile bütünleştirilerek doku bütünlüğü, fiziksel mobilite, öz bakım ve beslenmeye yönelik bireyselleştirilmiş dört hemşirelik bakım planı oluşturulmuştur. Hemşirelik girişimleri basınç yarası yönetimi, mobilitenin desteklenmesi, öz bakım aktivitelerinin geliştirilmesi, beslenmenin yönetimi, hasta ve aile eğitimi ile rehabilitasyon sürecine odaklanmıştır. İzlem süresince yeni basınç yarası, kontraktür, enfeksiyon veya yeniden gastrointestinal sistem kanaması gelişmemiş; hasta fonksiyonel kapasitesi doğrultusunda rehabilitasyona aktif katılım göstermiş, aile bireyleri ise bağımlı bakım ajanı olarak bakımın sürekliliğini desteklemiştir. Bu olgu, Orem'in Öz Bakım Eksikliği Kuramı'nın karmaşık postoperatif nörolojik komplikasyonlarda bireyselleştirilmiş hemşirelik bakımının planlanması ve uygulanmasında uygulanabilir ve sistematik bir çerçeve sunduğunu göstermektedir.

Anahtar Kelimeler

• Olgu Sunumu
• Lomber Disk Hernisi
• Hemşirelik Bakımı
• Orem'in Öz Bakım Eksikliği Kuramı
• Parapleji.

Destekleyen Kurum

Yok

Proje Numarası

None

Etik Beyan

Bu çalışma olgu sunumu niteliğinde olup hastadan yazılı bilgilendirilmiş gönüllü onam alınmıştır.

Teşekkür

Bu olgu sunumunun hazırlanmasına izin veren ve yazılı bilgilendirilmiş gönüllü onam veren hastaya katkılarından dolayı teşekkür ederiz.

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