一位再次截肢冷凝球蛋白血症患者之護理經驗

The Nursing Experience of a Re-amputation Patient with Cryoglobulinemia

本文描述一位罹患冷凝球蛋白血症的未婚女性，因傷口反覆潰瘍面臨再次截肢引發心理衝擊之護理經驗。筆者於2008年2月27日至4月20日護理期間，透過身體評估、觀察、會談、直接護理及病歷查閱等方式收集資料，運用羅氏適應模式進行整體性評估，發現個案有傷口疼痛、身體心像改變、無力感等健康問題。透過主動關懷、陪伴，提供疾病相關資訊來建立互信關係，教導與鼓勵參與傷口的換藥，利用轉移注意力來減緩身體的傷痛。介紹類似疾病之病友分享經歷疾病過程的內心衝擊及因應方式，同時強化與重要親友的情感連結來凝聚支持，以提升自我照顧之技巧並肯定存在之價值，讓其能逐漸適應身體外觀的轉變並以正向態度面對截肢後之生活。希望藉此護理經驗分享照護年輕截肢女性患者，除了減輕疾病對其身體造成之傷痛，更應重視身體外觀改變對其內心衝擊照護之獨特性。

This article describes the nursing experience of a young single female amputation patient with Cryoglobulinemia, whose ulcer wound brought infection and resulted in re-amputation and subsequent mental health problems. Information was collected via physical examination, observation, interview, direct nursing, and chart review from February 27, 2008 to April 20, 2008. In addition, evaluation by Roy’s Adaptation Model revealed that this patient had wound pain, disturbed body image, and a feeling of powerlessness. An attempt was made to improve her self-care and encourage development of the patient’s self-esteem with the assistance of and support from her family and boyfriend. Strategies taken included establishing trust and communication, listening to her concerns and feelings, providing diseaserelated information assistance, teaching her to care for her amputation wound, changing her focus from the amputation to pain relief, and introducing and sharing experiences with other patients. It is hoped that through this nursing experience, we can provide better information on how to effectively relieve physical pain from such patients and pay more detailed attention to the unique impact of negative body images on younger female patients.