照顧一位中年男性因周邊動脈疾病面臨截肢之護理經驗

一位不慎產生燙傷傷口又併發周邊動脈疾病導致面臨右下肢截肢手術的中年男性病患，截肢術後的健康問題多元。於2020年6月14日至7月4日照護期間，依生理、心理、社會及靈性面向，透過直接照護、觀察及會談等方式確立周邊動脈組織灌流改變、身體心像紊亂、急性疼痛、身體活動功能障礙、知識增進準備度健康問題。藉由鼓勵個案表達對外觀改變的感受建立正向身體心像；提供藥物及非藥物治療緩解疼痛，利用鏡像治療改善幻肢痛；以殘肢肌力訓練、漸進性復健，使個案出院前能使用輔具自行移位行走；提供出院後截肢傷口照護、周邊動脈疾病預防指導，使個案提升照護知識增進準備，建立自我照護與因應的信心。周邊動脈疾病致截肢病患的心理衝擊與對未來因應的準備，須在截肢術後盡早介入。受限缺乏病友關懷團體資源與資訊，致病友的社會支持介入較耗時。期許藉由此個案照護經驗分享，提醒醫院護理人員對於截肢術後病患照護，除生理不適外，也能提供心理、社會與靈性問題的整體性評估與照護。建議應考量人口學特性、截肢原因、因應動機及自我照護能力，還有家庭與社會的支持程度等狀況，提供病患個別化措施與出院後持續照護資源。

關鍵字

周邊動脈疾病；截肢；中年男性

並列摘要

A middle-aged male patient, who inadvertently suffered from burn wounds and also complicated peripheral arterial disease, facing right lower limb amputation, encountered multiple health problems after amputation. From June 14th to July 4th, 2020, based on physical, psychological, social and spiritual aspects, was assessed through direct care, observations, and therapeutic interviews. It was determined that the health issues included peripheral arterial perfusion change, acute pain, body image disturbance; physical activity dysfunction and knowledge enhancement readiness. Establishing a positive body image by encouraging the patient to express his feelings about changes in appearance; providing medication and non-pharmacological management to relieve pain and using mirror therapy to improve phantom limb pain; using residual limb muscle training and progressive rehabilitation to enable the patient to use assistive devices to move himself before being discharged from the hospital; providing post-discharge care education about amputation wounds and prevention of peripheral arterial disease to improve the patient's nursing knowledge and preparation; and building confidence in self-care and coping were all applied in a timely manner. The psychological impact of amputation for patients with peripheral arterial disease and preparation for future response must be intervened as soon as possible after amputation. However, due to the limited resources and information of patient care groups, intervention of social support for patients is time-consuming. It is hoped that through sharing this nursing experience, the hospital nurses will be reminded that in addition to physical discomfort, they can also provide comprehensive assessment and care of psychological, social and spiritual problems when caring for patients after amputation. It is recommended to take demographic characteristics, the cause of amputation, the motivation of coping, self-care ability, and the degree of family as well as social support into consideration when providing patients with individualized measures and continuous care resources after discharge from the hospital.

並列關鍵字

peripheral arterial disease ； amputation ； middle-aged male

參考文獻

何頌揚、何姍蓉（2015）．從轉譯科學觀點探究鏡像治療於幻肢痛之轉譯過程．臺灣職能治療研究與實務雜誌， 11(1) ， 50-58 。https://doi.org/10.6534/jtotrp.2015.11(1).50

林瑞英、李淳權、黃琪峰（2019）．一位糖尿病人面臨截肢困境之護理經驗．馬偕護理雜誌，13(2)，64-73 。 https://doi.org/10.29415/JMKN.201907_13(2).0006

Yen, C. C., Chiu, Y. W., & Chen, H. C. (2016). Lower extremity peripheral artery disease in end-stage renal disease: A literature review. Journal of Internal Medicine of Taiwan,27(2), 68-78. https://doi.org/10.6314/JIMT.2016.27(2).03

Bennett, J. (2016). Limb loss: The unspoken psychological aspect.Journal of Vascular Nursing, 34(4), 128-130. https://doi.org/10.1016/ j.jvn.2016.06.001

Parnell, B., & Urton, M. (2021). Rehabilitation nursing challenges for patients with lower limb amputation. Rehabilitation Nursing,46(3), 179-184. https://doi.org/10.1097/RNJ.0000000000000289

主題瀏覽