照護一位下肢創傷後接受膝上截肢病人之護理經驗

The Nursing Experience of Caring a Patient who Had a Leg Amputation after a Traffic Accident

創傷導致肢體組織的感染壞死進而截肢，將可能出現有生、心問題，面對此衝擊病人需要協助調適。本文是一位25歲男性因下班途中車禍，導致右下肢開放性骨折及軟組織感染壞死，接受膝上截肢的護理經驗。筆者於2009年3月5日至5月18日護理期間，運用傾聽、會談及羅氏適應模式作為整體性評估，發現主要健康問題有組織完整性受損、急性疼痛、身體活動功能障礙及身體心像紊亂。護理過程中，生理方面提供完整的傷口照護計劃，協助攝取促進傷口癒合之營養素；藉由每班疼痛評估，提供肌肉按摩、深呼吸放鬆及轉移注意力之緩解技巧，配合換藥物料的選擇及動作輕柔，以減少換藥時導致的疼痛感；在肢體活動上則加強健側肌力訓練，促進早期下床及恢復日常生活能力；心理方面引導正視身體截肢部位，鼓勵表達創傷後截肢之內心感受，使個案能從外觀改變上重新學習適應，修正其負向看法，以提高自我肯定，並偕同家屬建立良好的支持系統，讓個案順利渡過調適的過程。

The necrosis of limb tissue caused by trauma-induced infection often requires amputation. The patient will need assistance to face the impact of surgery. This article describes the nursing experience of caring a 25-year-old man who had a traffic accident on his way back from work, resulting in soft tissue infection and necrosis caused by multiple open fractures on lower right leg extremity. We described the patient’s experience of receiving a knee amputation. According to Roy’s Model assessment, we found that the main problems of the patient included impaired tissue integrity, acute pain, impaired physical mobility, and body image disturbance. The nursing process consisted of providing a complete physical wound care program to help promote wound healing in the patient through an intake of nutrients. After each pain assessment, appropriate massaging was scheduled to relax the patient’s muscles and ease the pain. Another method used simultaneously involved the use of distraction breathing techniques. The nurse was also careful to use gentle movements in order to reduce the pain when changing the patient’s clothing that could otherwise be harmful to him. Through physical activities, progressive training was given to strengthen his amputated limb and to help the patient resume normal activities of daily life. The care of psychological aspect of amputation of a body part involved guiding the patient to encourage him to express his feelings so that the patient can learn to adapt the changes of his appearance. During this period, the author also maintained a good relationship with the patient’s family. All these elements combined improve the likelihood that the patient will recover smoothly through the process of adaptation to his newly amputated condition.