一位左膝上截肢患者的護理經驗

Nursing Care Experience of a Patient with a Left Knee Amputation

無論任何人經歷截肢手術，皆會面臨一個永久性的功能喪失，對於突如其來的改變，易造成生活及社交上很大的衝擊，而使個人產生重大挫折與自卑；住院中，如果病人無法面對身體心像上改變，出院後將容易導致憂鬱和社交隔離的情形。本篇個案報告是描寫一為因車禍意外而導致左膝上截肢個案，面對身體功能受損及心理衝擊、調適過程之護理經驗。筆者於94年5月10至94年6月30日擔任其主護護士，經由觀察、會談、傾聽、身體評估、病歷查閱等方式收集資料，並運用Gordon十一項健康功能型態進行護理評估，確立個案主要護理問題有：急性疼痛、組織完整性受損、身體心像紊亂等三項。護理期間筆者以傾聽、陪伴、主動關懷、協助身體照顧和支持、鼓勵表達和宣洩情緒來了解個案心中感受，在家屬、看護配合下協助個案面對截肢的事實使個案重新調適新的生活，希望藉此護理經驗的分享及文獻的探討，能提供護理人員重視截肢個案身體、心理調適狀況，作為以後照顧此類個案之參考。

This case report illustrates the nursing care of a patient who had an amputation at the left knee, which was caused by a motor accident; this had resulted in body impairment and mental impacts. The nursing period was from 94/5/10 to 94/6/30 and the nurse carried out observations, conversations, listening, physical assessments and reviewed the medical records in order to collect data. On applying the eleven functional health patterns as described by Marjory Gordon, it was found that the nursing assessment clarified certain nursing issues including acute pain, impaired skin integrity and body image disturbance. The authors provided company to the patient and gave her support in order to adjust to the fact that there had been loss of a leg. We would like to share our experiences with this case in order to provide more information to our profession on caring in such a situation.