照顧一位幼兒因右腳拇趾壓傷後壞死而截肢之護理經驗

本文是描述一位2歲3個月幼兒因右腳拇趾壓傷後壞疽而截肢之護理經驗，照護期間為2015年1月14日至2月7日，筆者運用Gordon十一項健康功能評估為指引，透過觀察、會談、身體評估及病歷資料，進行資料的收集，確立個案有急性疼痛、恐懼、身體活動功能障礙及案母有照顧者角色緊張等健康問題。在護理過程中，筆者以主動關懷、應用傾聽和溝通技巧，與個案和主要照顧者建立信任的護病關係，依據幼兒的認知與發展特質，以治療性遊戲和個案熟悉的用物，與個案建立關係，降低住院的害怕和疼痛，使個案可以跟隨護理人員的指導完成截肢術後的傷口照護；鼓勵主要照顧者共同參與照護，提供心理支持與截肢手術前後的照護知識，降低主要照顧者的心理衝擊，增加其照護信心。期望藉由此個案照護經驗的分享，提供護理人員臨床照護的參考。

關鍵字

幼兒；截肢；治療性遊戲；護理

並列摘要

This paper describes the care experience in a 2-year-and-3-month old child after amputation due to right big toe gangrene after crush injuries, from January 14 to February 7, 2015. Under the guidance of the Gordon 11 Functional Health Patterns, the author collected information through observations, conversations, physical assessments and medical records, and determined that the child had acute pain, fear, and physical activity disorders, while the mother presented caregiver role strain. Through proactive care, listening, and communication skills, the author established a trust relationship with the child and the family. According to the development characteristics of children, the author applied therapeutic play with the child to reduce fear and pain, thus, the child could follow the nurse's instruction to complete wound care after amputation. The author encouraged the caregiver to participate in the planning and provision of care, and provided the caregiver with psychological support and nursing knowledge about the amputation, further enhanced the caregiver' confidence in caring their child. The author hopes that this paper may serve as a reference for similar nursing cases in the future.