照顧一位壞死性筋膜炎患者之護理經驗

The Nursing Experience of a Necrotizing Fasciitis Patient

余庭婕(Ting-Chieh Yu) ； 黃煒淇(Wei-Chi Huang) ； 蔡麗紅(Li-Hung Tsai)

《長庚科技學刊》 28期 (2018/06) Pp. 107-117

https://doi.org/10.6192/CGUST.201806_(28).11

摘要

本文旨在描述一位壞死性筋膜炎患者，因反覆執行清瘡手術，所造成的生理及心理衝擊之護理經驗。護理期間自2015年01月28日至02月21日。在照護期間運用Gordon十一項健康功能型態為評估架構，確立個案有：「組織完整性受損」、「急性疼痛」及「焦慮」之健康問題。於護理過程中，執行傷口照護、提供傷口癒合所需的營養之相關訊息，以及教導執行下肢等長運動，以促進血液循環，進而促進傷口癒合；換藥前先給予止痛劑、提供疼痛緩解的技巧、換藥過程中動作輕柔、以生理食塩水潤濕傷口再移除紗布，並且先用生理食塩水沖洗大量的分泌物，以減少傷口受到棉枝的摩擦，來減輕疼痛；藉由同理心建立良好護病關係、鼓勵個案說出內心感受、提供疾病相關資訊，並針對個案所提疑問給予說明，以減輕其焦慮。盼藉此經驗能提供護理人員作為日後在照顧類似病患之參考。

關鍵字

壞死性筋膜炎 ； 急性疼痛 ； 組織完整性受損 ； 焦慮

並列摘要

This case report described the nursing experience of patient with necrotizing fasciitis, who suffered from physical symptom and psychological impact, due to repeated debridements. The care period was between January 28 to February 21, 2015. Using Gordon's 11 functional health patterns as framework, the result indicated that the patient's nursing problem including impaired tissue integrity, acute pain, and anxiety. During the nursing process, the author provided tailored nursing care plans of appropriate nutrition, wound care, and isometric exercise of lower limbs to promoting wound healing. Reducing the patient's pain including applied analgesics before change dressing, provided pain relief skill, gentle applications during wound care, remove the gauze after wetted, and used normal saline to wash the wound at beginning change dressing to reduce the pain from the process cotton friction. Providing empathy to establish a trust relationship, encourage the patient to express feelings, providing information about the disease, and answer the patient's doubts to reduce the patient's anxiety. By sharing the nursing experience, the author would like to provide a reference for nursing personnel when attending to similar cases.

並列關鍵字

necrotizing fasciitis ； acute pain ； impaired tissue integrity ； anxiety

參考文獻

Beldon, P. (2013). How to select and choose appropriate wound dressings. Nurse Prescribing,11 (10), 487-492.

Davoudian, P., & Flint, N. (2012). Necrotizing fasciitis. Continuing Educ- ation in Anaesthesia,Critical Care & Pain, 20 (5), 245-250.

Fodel, L. P., & Smith, A. M. (2014). Necrotizing soft tissue infections: A review of diagnosis,management, and implications for NP practice.The Journal for Nurse Practitioners, 10 (4), 245-248.

Francis, L., & Fitzpatrick, J. J. (2013). Postoperative pain: Nurses' knowledge and patients' experiences. Pain Management Nursing, 14 (4),351-357.

Gunderson, C. G. (2011). Cellulitis: definition,etiology, and clinical features. The American Journal of Medicine, 124 (12), 1113-1122.