照護壞死性筋膜炎患者行左肘下截肢之急診護理經驗

Experience of Emergency Nursing Care for a Patient with Necrotizing Fasciitis and Left Below-Elbow Amputation

洪美鳳(Mei-Feng Hong) ； 陳冬蜜(Tung-Mi Chen) ； 練美華(Mei-Hua Lien) ； 周嫚君(Man-Chun Chou)

《榮總護理》 34卷1期 (2017/03) Pp. 69-77

https://doi.org/10.6142/VGHN.34.1.69

摘要

壞死性筋膜炎病程進展迅速，除手術清創甚至截肢外，更造成呼吸衰竭引發死亡。本文探討一位62 歲肝硬化患者，因皮膚紅腫導致壞死性筋膜炎行左肘下截肢之急診照護經驗。筆者於2014 年7 月27 日至30 日，運用Gordon 十一項健康功能型態評估，採直接護理、觀察會談、資料收集及追蹤訪談等方式，收集主、客觀資料加以分析整理，確立個案有健康「疼痛」、「身體心像紊亂」、「呼吸道清除能失效」健康問題。運用耐心、傾聽及陪伴，鼓勵表達和宣洩情緒，瞭解個案心中感受，並偕同家屬共同參與照護活動，重建正向的自我概念，藉此經驗分享在照護壞死性筋膜炎患者時，除維持生命徵象穩定外，更需重視其心理擔憂、截肢後返家照護及社會適應層面的問題。

關鍵字

壞死性筋膜炎 ； 截肢 ； 身體心像紊亂

並列摘要

Necrotizing fasciitis is invariably followed by sudden deterioration with rapid progression. Patients with necrotizing fasciitis, apart from surgical debridement or even amputation, may easily develop respiratory failure and eventually die. This paper explores the experience of emergency nursing care for a 62-year-old male patient with cirrhosis. The patient had necrotizing fasciitis due to skin swelling and rashes; his left arm required amputation below the elbow. From July 27 to 30, 2014, the researcher used Gordon's 11 functional health patterns to perform direct nursing, observations, interviews, data collection, and track interviews. Analysis and rearrangement of the subjective and objective information that was collected confirmed that the patient had health problems of pain, body dysmorphic disorder, and failure of respiratory tract clearance function. Listening to the patient and accompanying him with patience, the researcher encouraged him to express and vent his emotions. Having understood the patient's feelings, the researcher encouraged his family members to join the nursing and caring activities, and the patient gradually faced and accepted the fact that his arm needed to be amputated. Through this experience, the researcher would like to share with other nursing staff that when nursing patients with necrotizing fasciitis, we need to not only maintain the stability of the patient's vital signs but also pay attention to other problems that the patient might be experiencing such as psychological concerns, home care after amputation, discharge from hospital, and adaptation to society. We should assist patients in rebuilding their confidence in life, and enable them to redevelop a positive attitude toward human life.

並列關鍵字

necrotizing fasciitis ； amputation ； body dysmorphic disorder

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