一位青少年骨肉瘤合併糖尿病行膝上截肢之照護經驗

本文描述一位17歲罹患左脛骨骨肉瘤行肢體保留手術之病人，因術後嚴重感染接受左膝上截肢手術之照護經驗。護理期間自2014年7月20日至8月2日，以Gordon十一項功能性健康型態評估，藉由直接照護、會談、傾聽等方式收集資料，確立健康問題有急性疼痛、身體活動功能障礙、身體心像紊亂、特定與疾病相關部份知識缺失。照護過程中配合青春期的發展特性，包括選擇喜愛音樂轉移對疼痛感受；鼓勵參與護理及復健活動，解決截肢所造成的身體活動受限問題；提供衛教手冊學會飲食替換，了解血糖控制的重要性；利用傷口照護護理手冊，能正確執行無菌換藥技術，在心靈層面則運用身體心像重建四大階段，針對各期給予適切之護理措施，鼓勵個案表達感受，讓個案正視自己外觀的改變，積極參與日常生活照顧活動，使個案更快適應截肢後生活，早日回歸返校生活。

關鍵字

青少年；骨肉瘤；糖尿病；膝上截肢

並列摘要

This article reports our experience in caring for an adolescent receiving left above-knee amputation due to intractable infection after limb-salvage surgery for osteosarcoma over the left proximal tibia. The primary care was carried out from July 20th to August 2nd in 2014. We collected our data from clinical observation and patient interview, and assessed the patient by using Gordon's 11 functional health patterns. The major clinical nursing issues included acute postoperative pain, impaired physical mobility, body-image disturbance, and a lack of disease-related knowledge. The nursing strategy was provided according to his specific developmental milestone in adolescence and focused on reducing pain by listening to music, encouraging active rehabilitation, and reducing physical limitation after amputation. We also provided the patient with handbooks In regarding to wound care techniques and control with nutrition control after the surgery. terms of psychosocial aspect, we focused on four major stages of body-image reconstruction and encouraging him to express emotion properly and inducing optimistic attitude to the change of his body-image. We also encouraged him to actively participate other daily activities, which would help him to adapt himself to his new life and return to school as quickly as possible.

並列關鍵字

adolescent ； osteosarcoma ； diabetes mellitus ； above-knee amputation

國際替代計量

一位青少年骨肉瘤合併糖尿病行膝上截肢之照護經驗

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