照護一位全身嚴重燒傷併右膝下截肢青少女之護理經驗

Nursing Experience of Caring for an Adolescent Receiving Below-Knee Amputation Due to a Severe Burns Accident

本文探討一位青少女原本外型亮麗，卻因意外造成全身嚴重燒燙傷導致右膝下截肢的照護經驗，個案在病情穩定後轉入病房進行後續照護，卻出現易怒、大哭、拒絕復健等身體心像紊亂行為。筆者自2015年9月8日至9月18日照護期間，運用 Gordon 十一項健康型態功能評估作為指引，運用觀察、會談及傾聽技巧收集相關資料，確立個案有疼痛、身體活動功能障礙和身體心像紊亂等護理問題。護理過程中，除了處方止痛藥使用外，換藥方面藉由選用特殊敷料減少換藥頻率和輕柔換藥技術配合刺激大神經來減輕換藥疼痛；復健前先以中性乳液塗抹滋潤皮膚和復健時搭配腹式呼吸放鬆和轉移注意力技巧調適復建不適；截肢護理以加強健側肌力、站立平衡訓練促進早期下床並為日後穿上義肢做準備；心理方面，鼓勵面對外觀上的改變，強調個人自我正向特質，以提高自我肯定。藉由分享媒體新聞了解社會大眾適應程度以降低身心威脅，以及使用網路傳播軟體分享復健過程，獲得同儕支持調適逆境衝擊。教導穿著喜歡的長袖、長褲以減少外表和他人的差異，促使接納病患。本文建議希望國內能成立專門青少年截肢病患的支持團體，將青少年截肢支持團體納入照護計劃中，以支持團體協助青少年截肢病患渡過艱辛漫長的復健歷程。

This study describes the nursing experience of caring for a bright adolescent girl whounderwent a below-knee amputation due to severe burns. The case was transferred to theward for follow-up care after reaching a stable condition, but displayed irritability, crying,refusal to rehabilitate, and other inappropriate behaviors. The authors collected data by meansof observation, interview, and listening during the nursing period from September 8 to 18,2015. After an assessment as made using Gordon's 11 Functional Health Pattern AssessmentTool, the case was identified with nursing problems of pain, physical activity limitations, andbody image disturbance associated with serious burns. In addition to the use of prescriptionpainkillers, the nursing process involved using special dressing, reducing the dressing changefrequency, gently changing dressing, and stimulating the nerves to reduce pain. Before therehabilitation, neutral lotion was first applied to the skin for moisturizing and reducingfriction. During rehabilitation, the case was taught to adopt abdominal breathing forrelaxation and attention diversion techniques in order to reduce the discomfort. Theamputation care focused on strengthening muscles on the left side and balance trainingpreparing her for ambulation and future prosthetic wear. Psychological care includedencouraging the acceptance of changes in appearance and emphasizing the positive qualitiesof oneself in order to improve the patient's self-esteem and prepare her to respond to others'negative reactions. Through media and news, the case became aware of the acceptance level of the public toward burn victims in order to reduce the physical and emotional threats. Thecase also shared her rehabilitation progress on the Internet, thus receiving peer support andadapting to adverse challenges. She learned how to dress herself in her favorite long-sleeveshirts and pants in order to minimize the apparent differences from others. This studyrecommends that health care authorities should set up special teen amputee support groups,and include those teens in long-term care plans, thus allowing support groups to provideassistance to them throughout their long and arduous rehabilitation process.