- 期刊
照護一位多重創傷伴隨身體心像紊亂個案之加護經驗
Nursing Experience of a Patient with Multiple Trauma and Body Image Disturbance in Intensive Care Unit
摘要
本文為探討一位正值成年早期歷經車禍創傷導致顏面骨、四肢多處粉碎性骨折合併右眼失明之加護經驗，因重大創傷造成身體心像巨大改變而出現憤怒、哭泣、沉默等情緒故引發探討動機。照顧期間於2020年11月21至12月10日，藉由身體評估、觀察、筆談及查閱病歷等方式收集資料，確立個案有身體心像紊亂、呼吸道清除功能失效、急性疼痛等健康問題，擬定個別性護理計畫及活動，協助因應調適之過程。在顏面重建整形術後因鼻腔填塞、齒齦綁鋼絲固定、顏面及呼吸道腫脹，予預防肺炎組合式照護措施、加強翻身抽痰等，促使痰液排除；運用階梯式疼痛與非藥物措施，有效控制急性疼痛並且協助輔具使用，維持肌力預防關節攣縮。然而，多重創傷後外觀改變與成年早期失明使個案面臨強大的心理衝擊，經建立信任感後，鼓勵抒發感受，並提供病友與公眾人物案例分享，重建身體心像與增強自我觀感。建議未來能運用創傷後壓力疾患風險心理評估，早期協助心理調適，提供更全面的身心照護。
並列摘要
This paper explores a patient in early adulthood who experienced facial bone fractures, comminuted extremity fractures, and blindness in the right eye after a traumatic accident in an intensive care unit. The patient's body image has undergone a tremendous change due to the major trauma which led to the emotional reactions such as anger, crying, and silence. The patient's experience and reactions motivated the author's for discussion. The data was collected through physical examinations, observations, written interviews, and a review of medical records from November 21 to December 10, 2020. The health problems identified were body image disturbance, ineffective airway clearance, and acute pain. Individualized care plans and interventions were implemented to promote the patient's coping and adaptation. Following facial plastic surgery, patient had nasal packing and required wires for gingival fixation, which led to facial and airway swelling. The ventilator-associated pneumonia bundles for pneumonia prevention was provided and the changing position and suction were enhanced to facilitate the removal of sputum. Besides, a stepwise approach to pain management, including non-pharmacological measures was employed for acute pain control. The assistive devices were used to maintain muscle strength and prevent joint contractures. Although the patient experienced tremendous mental stress due to blindness and changes in appearance, he has rebuilt his body image and self-perception through a strong nurse-patient relationship, and be encouraged to share his feelings and experiences with other patients and public figures. The application of psychological risk assessments to identify posttraumatic stress disorders is suggested to promote mental adaptation in the early stage and provide comprehensive physical and mental care.