照護一位周邊動脈阻塞性疾病引發雙腳傷口感染壞疽病人之護理經驗

Nursing Caring Experience of a Patient with Wound Infection and Foot Gangrene Caused by Peripheral Arterial Occlusive Disease

翁禎翎(Chen-Ling Weng)

《源遠護理》 14卷2期 (2020/07) Pp. 60-66

https://doi.org/10.6530/YYN.202007_14(2).0008

摘要

本文係探討一位周邊動脈疾病引起雙腳腳趾傷口感染及壞疽病人之護理經驗。筆者於2017年9月23日至11月2日照護期間，運用Gordon 11項健康功能評估作為評估工具，並利用觀察、會談、身體評估等方式收集資料，經分析歸納後發現個案主要護理問題為組織完整性受損、急性疼痛，及焦慮。個案因長期獨居，擔心自己出院後會缺乏生活自理能力，因此在護理過程中指導個案傷口照護知識及技巧，增加自我照顧能力。藉由減少疼痛刺激源、轉移對疼痛的注意力等方法來協助減輕疼痛。同時透過醫護人員之鼓勵、支持及陪伴，並藉由病友經驗分享，以強化個案正向行為及態度，增強個案對治療計畫之信心，並引導個案配合運動治療，增進日常活動能力，以減輕焦慮感受。此外，透過社工聯繫，提供獨居個案出院後之照顧及支持系統，協助個案返家後能獲得持續性的健康照顧服務。藉此照護經驗分享，期望能提供護理人員照護獨居病人傷口照護之參考，提供更完整的照護品質，進而幫助病人回歸正常的健康生活型態。

關鍵字

週邊動脈疾病 ； 傷口照護 ； 護理照護

並列摘要

This article reports nursing care of a patient with peripheral arterial disease complicated with wound infection and gangrene in toes bilaterally. During the care period between September 23 and November 2, 2017, the author collected assessment data by observation, conversation and physical assessment. The patient lived alone and was concerned about inability to care for self after discharge. The Gordon's 11 health function assessment identified patient's main health problems were impaired tissue integrity, acute pain and anxiety. Nursing interventions included helping patient to accept the disease status with a positive learning attitude, teaching patient knowledge and skills in wound care, and increasing patient self-care abilities. Avoid direct touch of the painful area and distraction to manage pain. Encouraged patient's positive attitudes and behavior, provided staff companionship, increased patient's confidence in the treatment plans, shared her experience with other peers when appropriate, and participated in exercise therapy and daily activities. Social worker interventions included provision of a care and support system post discharge to ensure continuous care at home. This care experience may provide insight into caring for patients who live alone, for a more complete quality of care, and to help them resume normal life at home.

並列關鍵字

peripheral arterial disease ； wound care ； nursing care

參考文獻

Leder, D. (2018). Coping with chronic pain, illness and incarceration: what patients and prisoners have to teach each other (and all of us). Medical Humanities, 44(2), 113-119. doi:10.1136/med-hum-2017-011426

陳瑜亮、李聰界（2018）．腳麻走不動淺談週邊血管阻塞性疾病PAOD．彰基院訊，35（8），14-15。

Alzghoul, B. I., & Abdullah, N. A. (2015). Pain man-agement practices by nurses: An application of the knowledge, attitude and practices (KAP) model. Global Journal of Health Science, 8(6), 154-160.

Bonham, P. A., Flemister, B. G., Droste, L. R., John-son, J. J., Kelechi, T., Ratliff, C. R., & Varnado, M. F. (2016). 2014 guideline for management of wounds in patients with lower-extremity ar-terial disease: An executive summary. Journal of Wound, Ostomy, and Continence Nursing, 43(1), 23-31.

Dissemond, J., Kroger, K., Storck, M., Risse, A., & Engels, P. (2015). Topical oxygen wound ther-apies for chronic wounds: A review. Journal of Wound Care, 24(2), 53-54, 56-60, 62-63.