照顧一位多次骨髓炎復發行膝下截肢病人之護理經驗

The Nursing Experience of a Multiple Recurrent Osteomyelitis Patient Receiving Below-Knee Amputation

本文探討一位多次復發性骨髓炎行膝下截肢患者，面對身體功能受損及心理衝擊過程之護理經驗。護理期間自2008年2月11日至2月17日，經筆者與個案建立信任關係後，運用Gordon十一項功能性健康評估模式、病史收集、身體檢查、觀察、會談與病人溝通互動，收集主、客觀資料，來進行整體性評估。確立個案有：焦慮／擔心手術過程及傷口預後不佳、疼痛／截肢後傷口疼痛及幻肢痛、身體活動功能障礙／右膝下截肢造成身體活動受限及身體心像紊亂／右膝下截肢造成身體外觀及功能改變等護理問題。護理過程中筆者以傾聽、主動關懷並接納個案心中感受，針對個案需求，給予個別性及獨特性護理計畫及衛教，以減輕焦慮、降低截肢造成的幻肢痛，鼓勵勇敢面對截肢的事實進而主動學習助行器的使用，使個案更快適應截肢後的生活。經過持續照護，在個案返家後，三次電話追蹤中，個案已能著義肢完成日常生活功能及回歸正常生活。希望藉此護理經驗的分享，提供護理人員面對相同個案時，能兼顧身心靈照護之參考。

The article describes a nursing process of a multiple recurrent osteomyelitis patient facing impaired physical function and psychical impact after receiving below-knee amputation. The duration of nursing care was between February 11 to February 17 in 2008. The author used Gordon 11 functional assessment, chart reviews, physical assessment, observation, interviews, and communication to collect subjective and objective data. The patient’s problems were identified as the following: anxiety/worried about operation process and wound healing, acute pain/amputation wound and phantom pain, impaired physical mobility/right below knee amputation and disturbed body image/ right below knee amputation. During the nursing process, the author offered individual nursing intervention to relieve the patient’s anxiety, and to release phantom pain by listening, receiving, and caring patient’s feelings. The author also encouraged the patient facing the reality a change of the body and learning how to use a walker to assist his daily life. In addition, the result of tree times telephone follow-up found that the patient had been using prosthesis to complete the daily life and to return a normal life. This case report aims to share the nursing experience and provide reference for physical, mental and spiritual caring for similar cases.