一位電燒傷導致上肢截肢患者之護理經驗

本篇報告描述一位工作中不慎觸電，因電燒傷導致左肘上截肢個案之護理經驗。筆者於2021年1月22日至2月22日照護此個案，運用同理、支持、關懷及接受等技巧，與個案建立良好護病關係，使用Gordon十一項功能性健康型態評估，以觀察、傾聽、會談、查閱病歷、團隊討論及身體評估等方式收集資料，發現個案有：自我照顧能力缺失、急性疼痛及增進因應能力的準備度三項健康問題。針對個案之健康問題給予護理措施如：1.教導並協助製作輔助餐具和盥洗用具以提升自我照顧能力；2.聯合復健師教導鏡像治療、輕拍或按摩殘肢，及聽音樂、看影片等轉移注意力方法減輕幻肢疼痛；3.聯合社工師提供社會福利團體及身心障礙補助資訊，協助了解社會資源。照護期間發現本院未設截肢病友支持團體，以致無法協助轉介參與，建議未來能和社工、復健師及輔具中心共同規劃支持團體。於照護燒傷致截肢患者期間，除傷口護理外，更需察覺患者缺少肢體後之生、心理改變及需求，並給予其家庭更多支持及協助，因嚴重電燒傷導致上肢截肢之個案並不常見，期望藉此護理經驗，提供日後臨床護理人員照護燒傷合併截肢患者時，能有所參考，並針對患者之問題給予適當護理措施，以提升生、心理舒適及重返社會之信心。

關鍵字

電燒傷；截肢；自我照顧能力；疼痛；因應能力

並列摘要

This case report describes the nursing experience of upper left elbow amputation caused by electric burn due to work injury. The author took care of the case from January 22 to February 22, 2021, utilizes the skills of empathy, support, care and acceptance, established a good nursing relationship. Based on Gordon 11 Function Health Patterns Assessment, identify three of the patient's major health problems include: lack of self-care ability, acute pain, and readiness to improve coping capacity. Appropriate care measures were provided to improve the patient's problems, including: teach and assist in making auxiliary tableware and toilet utensils to improve self-care ability; cooperate with the rehabilitation division to teach image therapy, tapping or massaging the residual limbs, and other diversion methods to reduce phantom limb pain; cooperate with social workers to provide information on social welfare groups and disability subsidies to help understand social resources. It was found that the hospital didn't set up a support group for amputees, so it was unable to assist in the referral. It's suggested that the support group should be planned together with social workers, rehabilitators and assistive device centers in the future. During the care, it was found that the hospital does not have a support group for amputee patients, so it is unable to assist in referrals and participation. It is suggested that in the future, we can plan support groups together with social workers, rehabilitation therapists and assistive device centers. During caring of the amputated patient, in addition to wound care, it's also necessary to be aware of the afterlife, psychological changes and needs of patients after they missed their limbs and provide more support and assistance to their families. Cases of upper limb amputation caused by severe electric burns are not common, it's anticipated that this nursing experience can be used for clinical nurses when caring patients with burns and amputation in the future. In terms of appropriate nursing provide for the patients to improve their health, psychological comfort and confidence in social reintegration.

並列關鍵字

electric burns ； amputation ； self-care ability ； pain ； coping ability

參考文獻

周煌智（2016）‧重大災難後燒傷病人的心理重建‧護理雜誌，63 (1) ， 36-41 。 http://doi.org/10.6224/JN.63.1.36

邱珮華、王玉琴（2021）‧照顧一位青年創傷後左膝下截肢之護理經驗 ‧ 長庚護理， 32(1) ， 104-114 。 http://doi.org/10.6386/CGN.202103_32(1).0009

林儷玲、林紹雯、李彩緣（2019）‧一位車禍截肢之中年男性患者之護理經驗‧秀傳醫學雜誌，18(1) ， 62-70 。 http://doi.org/10.3966/156104972019061801008

孫權宇、莊文怡（2020）‧一位糖尿病患者四肢燒傷之護理經驗‧新臺北護理期刊，22(2)，99-108。http://doi.org/10.6540/NTJN.20200 9_22(2).0009

陳生松（2016）‧我是職能治療師，燒傷復健路上我陪你‧護理雜誌， 63(1) ， 42-48 。 http://doi.org/10.6224/JN.63.1.42

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