一位左膝下截肢個案之護理經驗

A Nursing Experience of Caring for a Patient with Below-Knee Amputation

本個案為55歲女性，因車禍導致左膝下截肢，對其身體功能適應、生活社交及自我價值方面皆造成莫大的衝擊，筆者護理期間自2011年2月26日至3月5日，運用羅氏適應模式評估以傾聽、會談觀察記錄資料收集，確立個案護理問題為疼痛、截肢手術後移位擺位之知識不足、身體心像紊亂等三項護理問題。運用傾聽、陪伴、鼓勵表達、示教、回覆示教及與家屬之間的相互合作，提供個別性護理，運用教導深呼吸、聽音樂、看連續劇等協助緩解術後疼痛；使用蜜粉刷及按摩殘肢來對患肢感減敏感；另外，提供易懂的殘肢移位擺位示範來糾正錯誤觀念，避免將來肢體變形；最後，利用全家成員尤其是小孫子的互動及接受，提升個案對自我自我價值。希望能藉由此護理經驗分享，能提供類似此長輩的身心照護經驗參考。

This study describes a nursing experience of caring for a 55-year-old female who underwent a below-knee amputation secondary to a car accident. The impact of this event on the victim included having to adapt to changes in physical function, social life, and self-value. The nursing period was from February 26 to March 5, 2011. The Roy Adaptation Model was used for patient assessment. For data collection, the author actively listened to, interviewed with, and observed the patient. The identified nursing problems included pain, insufficient knowledge of post-operative body positioning, transfer of the lower left stump, and disturbances in body image. Through genuine listening and companionship, the author encouraged the patient to express her inner feelings, demonstrated to the patient body positioning and transferring with a return demonstration, and interacted with families to offer individualized care. Deep breathing, listening music, and watching soap operas were methods of post-operative pain relief for the patient. Using a soft brush and massaging the stump helped desensitize the patient's stump pain. Additionally, demonstrating body positioning with easily understood terms corrected the patient's misconceptions and avoided potential stump deformity. Lastly, interaction with the patient's family, especially grandchildren, and acceptance by them promoted the patient's self-value. The author wishes to offer such an experience as a reference for nurses taking care of similar patients.