照護一位壞死性筋膜炎病人截肢後低自尊之護理經驗

Nursing Experience from Caring Necrotizing Fasciitis Patient with Low Self-Esteem after Amputation

陳慧君(Hui-Chun Chen) ； 陳芝文(Chih-Wen Chen)

《領導護理》 21卷2期 (2020/06) Pp. 46-60

https://doi.org/10.29494/LN.202006_21(2).0005

摘要

壞死性筋膜炎是一種病程進展迅速的疾病，不易控制感染，常引發截肢。在截肢後造成身體功能上永久的缺陷及肢體的殘缺，內心往往出現自卑、憂鬱的心理狀態，以致低自尊而衍生負面情緒。本文是在描述一位中年男子因參加廟宇慶典的過火儀式，不慎燙傷右足底，引發傷口感染併發壞死性筋膜炎而截肢的案例，術後除了照顧傷口護理時，運用非藥物方法來緩解疼痛，參與復健過程外，心靈層面更是不可漠視。筆者在2015年9月1日至2015年9月20日，期間利用Gorden十一項健康型態評估和家屬互動，藉由觀察、會談、身體評估等方式來收集資料，進行整體性評估，歸納出病人有急性疼痛、身體活動功能性障礙及情境低自尊等護理問題，護理過程中，傾聽病人表達自己的感受外，接受病人截肢後內心衝擊等負面情緒，並在旁陪伴渡過低自尊時期，漸進式的觸摸自己的殘肢，慢慢引導接納截肢事實，克服內心的衝突並重新適應生活。希望藉此經驗分享，做為照護此類病人之參考，以期達到整體性護理及全人照顧之目標。

關鍵字

壞死性筋膜炎 ； 截肢 ； 情境性低自尊

並列摘要

Necrotizing fasciitis is a kind of disease that progresses rapidly, not easy to control the infection and often leads to amputation. After amputation, it causes permanent physical defects; incompleteness of the limbs; inferiority and melancholic often appear in the mind, resulting in low self-esteem and negative emotion. This article describes an amputation case of a middle-aged man who took part in a fire ceremony in a temple celebration, negligently scalded right sole, and resulting in wound infection with necrotizing fasciitis. In addition to take care of the wound after surgery, applying nondrug methods to relieve pain, apart from participate in the rehabilitation processes, the spiritual level cannot be ignored. During the period of September 1st to 20th in 2015, the author applied the Gordon's eleven health assessments and family interaction in order to collect information through observation, talks, physical assessment, and so on to conduct a holistic assessment. Patients were determined to suffer from nursing issues such as acute pain, physical activity dysfunction and low self-esteem. During the nursing process, apart from listen to the patient to express their feelings, accept the patient's psychological impact after amputation and other negative emotions, and also accompanied the patient through low self-esteem period. Hence gradually get the patient to touch his residual limbs, slowly guiding to accept the fact of amputation, to overcome the internal conflicts and readjust to life. I hope this experience can be shared as a reference for taking care of such patients, with a view to achieve the goals of holistic nursing and holistic personal care.

並列關鍵字

necrotizing fasciitis ； amputation ； situational low self esteem

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