一位重症併黴菌感染頭皮剝落病人身體心像紊亂之照護經驗

Impact of Body Image Disturbance on a Patient with Scalp Fungal Infection

本文旨在探討一位39歲因呼吸衰竭併頭皮全身多處黴菌感染入住加護病房個案之護理經驗。護理期間為2011年11月21日至12月16日，藉由觀察、會談、查閱病例等方式收集資料，運用Gordon十一項功能性健康模式評估發現個案主要護理問題有：（一）現存性感染／與頭皮及全身皮膚黴菌感染有關、（二）營養少於身體所需／與復食症候群有關、（三）身體心像紊亂／與疾病身體外觀改變有關，護理過程透過關懷及全人照護，給予皮膚照護、漸進性提供營養，並予正向鼓勵與支持，增進自信心，使個案接受身體外觀改變之事實，經由整體個別性照護，最終病人順利出院，並回歸正常生活，期望本文的照護經驗提供未來類似個案之參考。

This study is the nursing experience of a 39-year-old patient admitted in an intensive care unit for respiratory failure and multiple scattered fungal infection in the scalp and other skin areas. The nursing period was from November 21 to December 16, 2011. The case evaluation utilized Gordon's 11 Functional Health Patterns Assessment. The basic data were gathered through observation, interview and medical record review. The identified nursing problems were existing fungal infection in the scalp and other skin areas, malnutrition related to refeeding syndrome and body image disturbance secondary to disease-caused body appearance change. Using a caring and holistic approach, the nurse provided the patient with skin treatment and progressive supplement of nutrients. The patient accepted the consequence of changed appearance and had more body image-related self-confidence with the nurse's positive encouragement and support. The patient was smoothly discharged from the hospital under integral and individualized care and returned back to regular life. The author hopes that this nursing experience can be used as a reference for other nurses who care for patients with a similar diagnosis.