照顧一位大面積燒傷病人的護理經驗

Nursing Experience in Caring for a Major Burn Patient

黃文香(Wen-Shiang Huang) ； 莊寶玉(Pao-Yu Chuang)

《臺大護理雜誌》 15卷2期 (2019/07) Pp. 146-158

https://doi.org/10.6740/NTUHJN.201907_15(2).0014

摘要

本文描述照顧一位37歲男性因抽菸導致意外失火，造成臉部、軀幹及四肢燒傷，燒傷深度為2－3度占總體表面積（total body surface area, TBSA）82%個案之護理經驗。2016/6/7-9/7期間透過身體評估、病歷查閱及會談方式蒐集資料，依生理、心理、社會及靈性四大層面做整體性評估，確立健康問題有組織完整性受損、疼痛、焦慮與身體活動功能障礙。經採無菌技術傷口換藥，高蛋白飲食，指導癒合皮膚之保護方法，急性期提供止痛藥與利用手機、聊天以轉移注意力，緩解個案之疼痛不適。提供漸進式復健運動以改善肢體關節活動功能，促進自我照顧能力。個案因大面積燒傷擔心出院換藥與工作問題，藉由陪伴、傾聽，引導表達內心感受，協同家屬的關懷與支持，及早給予出院規劃、支持團體及轉介機構服務，增進舒適安全感以降低焦慮，使能順利返家生活及維持社會功能。建議大面積燒傷病人應採個案管理，持續提供居家照護及復健諮詢，儘早給予相關社會資源轉介及跨團隊照護。

關鍵字

燒傷 ； 焦慮 ； 身體活動功能障礙

並列摘要

This article described the nursing experience for a 37-year-old man who suffered second- and third-degree flame burn injuries over 82% of his total body surface area by smoking and causing an accidental fire. Data were collected from observation, interview, physical assessment, and medical records to evaluate his physical, psychological, social, and spiritual health from June 7 to September 7, 2016. Primary nursing problems included impaired tissue integrity, pain, anxiety, and physical activity dysfunction. Nursing care included aseptic burn dressing, high-protein diet, teaching about burn wounds, and skin protection after healing. Acutely, analgesics and other attention-diverting activities (such as using a smartphone and chatting) were provided. He underwent progressive rehabilitation to improve physical function and self-care. He concerned about wound dressing and job performance after discharge. Thus, companionship, listening, counseling, family support, discharge planning, support groups, and referral agencies were provide to comfort, reduce anxiety, and maintain socialization. We suggested severe burn patients should be handled individually. The nursing process should provide home care and rehabilitation counseling, relevant social resources, and multidisciplinary care as early as possible. This article can be a reference for nurses who specialize in the care of severe burn-injured patients.

並列關鍵字

burn ； anxiety ； physical activity dysfunction