照護一位海洋弧菌感染併壞死性筋膜炎個案之護理經驗

A Nursing Experience with a Patient Whose Hand was Infected with Necrotizing Fasciitis Caused by Vibrio vulnificus

李孟芳(Meng-Fang Li) ； 康瑞蘭(Jui-Lan Kang)

《新臺北護理期刊》 17卷1期 (2015/03) Pp. 87-97

https://doi.org/10.6540/NTJN.2015.1.009

摘要

本文描述個案因殺魚時不慎被魚刺扎傷左手第五指指縫間，遭受海洋弧菌感染併壞死性筋膜炎之護理經驗。照護期間為2012年7月17日至2012年8月13日，筆者經由直接護理、會談、傾聽、查閱病歷等方式收集資料，以Gordon十一項功能性健康模式作整體性評估，確認個案的主要健康問題有疼痛、焦慮、現存性感染、皮膚完整性受損、知識不足等五項健康問題。在護理措施包括：提供芳香療法、觀賞布袋戲來轉移對疼痛的注意力；以聆聽老歌音樂、提供平安符、談論稻田耕種的喜悅來緩解焦慮不安情緒；教導營養食物之攝取、遵守無菌換藥原則等護理措施來改善傷口感染；教導植皮術後照護，以促進皮膚的完整性；以教導傷口換藥技巧並回覆示教，來提升傷口自我照護。期望透過此次護理經驗的分享，提供護理人員照護相關個案的參考。

關鍵字

海洋弧菌 ； 壞死性筋膜炎 ； 焦慮

並列摘要

This paper demonstrates authors' nursing experience with a patient whose hand was infected with necrotizing fasciitis caused by Vibrio vulnificus while handling raw fish. Data were collected through nursing care, interviews, observation, and medical record review during hospitalization from July 17 to August 13, 2012. The Gordon's 11 functional health patterns were conducted during care to provide a comprehensive assessment. Five main health problems were identified, including pain, anxiety, current infection, impaired skin integrity, and lack of knowledge. The authors employed an alternative therapy, such as aromatherapy and Taiwanese Hand Puppet to mitigate attention on pain. Furthermore, music therapy and spiritual care, such as the use of fortune pouch and discussion of the joy of farming were utilized to alleviate anxiety. The authors offered proper nutrition care and appropriate wound dressing skills in accordance with aseptic management to improve wound infection. The post-care information on skin graft is also provided to improve skin integrity. Furthermore, to improve the self-care of wound, the families and patient are educated on the use of wound dressing through demonstration. This experience provided nursing staff with a reference for future care of similar patients.

並列關鍵字

Vibrio vulnificus ； Necrotizing fasciitis ； Anxiety

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