一位鏈球菌毒素休克症候群病童之加護護理經驗

Nursing Care Experiences of a Child with Streptococcal Toxic Shock Syndrome

本文個案為一個因鏈球菌感染併發毒素休克症候群而入住兒科加護病房之病童。筆者在2006年1月1日至2月16日一個半月的護理過程中，應用Gordon十一項健康功能評估、實際照護、觀察、會談及家庭評估個案，確立個案主要護理問題為：一、呼吸道清除功能失效。二、營養狀況少於身體需要。三、皮膚完整性受損。四、嚴重的社交隔離等問題。經團隊努力維持有效之呼吸、嚴格控制感染問題、維持營養補給以及細心的傷口照顧、並佈置一個熟悉且乾淨的環境教導家屬陪伴及照顧的技巧，使個案順利度過急性呼吸窘迫危險期而能自行呼吸、恢復正常意識及體重，且在案父母正確學習後續居家照護技巧下，個案雖因壞死性筋膜炎併發症致左足中趾及無名趾第一節小趾頭壞死不幸切除，但經過復健左足功能也近恢復。已於2006年9月復學，除左足部分趾頭切除所留之殘疾外，其餘健康功能狀態恢復良好。希望由分享此個案的照護經驗，做為醫療專業人員照護之參考，以提昇醫護專業照護品質。

This article discussed the nursing care experience of a streptococcus infected patient complicated with streptococcus toxic shock syndrome during 2006/1/1 to 2006/2/26. The author used Gordon’s method, direct care experience, observation, conversation, and family assessment device to evaluate the patient. The health problems included airway clearance dysfunction, malnutrition, damage of intact skin, and social isolation. By appropriate respiratory care, the respiratory distress and respiratory tract infection resolved. By using adequate nutritional supply, her consciousness recovered and body weight increased. By teaching her parents the correct post-discharge home care techniques, she regained function of her left foot despite of amputation of the necrotic left middle and little toes. She returned to school in full recovery in September 2006. By sharing our experiences of caring this case, we hope to improve the quality of professional nursing care.