一位糖尿病截肢病人術後身體心像改變之護理經驗

Nursing a Diabetes Patient Undergoing Amputation Surgery

本文描述一位因糖尿病足部傷口潰瘍癒合差而導致膝下截肢患者，面對身體功能受損及心理衝擊過程之護理經驗。在照護個案期間，以觀察、會談、身體評估等方式收集資料，並運用歐倫自我照顧需求概念，來進行整體性評估，確立病患有疼痛、身體功能活動障礙、自我照顧能力缺失、身體心像紊亂及知識不足等健康問題。護理過程中筆者以傾聽、主動關懷來接納患者心中感受，並與個案建立良好護病關係，取得家屬配合下，協助患者面對截肢的事實進而學習使用助行器及義肢步行技巧，使病患更快適應截肢後生活。希望藉此護理經驗的分享，能提供護理人員重視截肢患者身體、心理調適狀態以及照護方法，用以參考。

This paper presents the experience of nursing a female patient suffering from diabetes who had to cope with physical disability and mental anguish of undergoing a below-knee amputation due to the poor healing of a wound on her foot. We collected information by observation, interview and physical examination. We used Orem’s self-care theory to assess her systemic status and define health problems, including wound pain, de?cit of self-care ability, body image confusion and lack of adequate knowledge. In the process of nursing this patient, the author actively listened to the patient’s concerns and feelings, and established a good nurse-patient relationship. With the cooperation of her family, we helped the patient to confront the facts, learn how to use a walker and the arti?cial limb, and get used to post-amputation life more quickly. We would like to share this experience and encourage nurses to pay attention to a patient’s physical and mental status, as well as the methods of care used for post-amputation patients.