一位雙腳截肢併有壞死性筋膜炎手術後之個案照顧經驗

Nursing Experience of A Bilaterial Lower Extremity Amputation Patient with Necrotizing Fascitis Surgery

本文為探討一位雙腳截肢個案，因為髖部壞死性筋膜炎於南部某教學醫院住院行多次筋膜切開術及清創手術的護理經驗。護理期間自2007年9月12日至2007年9月28日，以Gordon十一項功能性健康型態評估，藉由觀察、會談、身體評估等方式進行資料收集及分析，發現主要健康問題為：(1)組織完整性受損、(2)疼痛及(3)動無望感。護理期間透過護理活動協助促進傷口癒合，指導個案及家屬藉由放鬆技巧等方法減緩疼痛，傾聽個案的表達及感受，並鼓勵主要照顧者共同參與照顧活動，使得個案壞死性筋膜炎傷口情況獲得改善並促進局部血液循環，減緩換藥時的疼痛，並願意表達內心感受。希望藉由此經驗分享，提供照護此類個案之參考。

This article describes a case study of nursing care for a patient with a bilateral lower extremity amputation. In a teaching hospital in southern Taiwan, the patient underwent multiple surgeries for debridement of necrotized tissue secondary to fascitis. The period of nursing care was from September 12(superscript th) to 18(superscript th) 2007. The author used Gordon's eleven functional health assessment as a tool in this case study. Through observation, interview, and physical assessment, data were collected and analyzed. The three major identified problems were impaired skin integrity, pain, and hopelessness. Nursing activities focused on healing of the wound, provision of patient/family education about pain relief listening to patient's expression with empathy, and encouraging caregiver's participation in caring activities. The patient's wound was healed with improved blood circulation. The patient's pain was relieved during dressing changes. The patient was willing to share feelings about being ill. The author hopes that this study report can serve as a reference for nurses taking care of patients with amputation.