照顧一位燒傷後導致右膝上截肢患者之照護經驗

A Nursing Experience of a Patient with Right Above-knee Amputation Caused by Burn Injury

本文描述一位32歲男性個案，因氣爆意外導致全身共29％二至三度燒燙傷，到院時右下肢因右膝膕動脈斷裂及嚴重的燒傷，緊急進行右膝上截肢手術之護理過程。筆者於2014年8月1日至8月22日照護期間，運用全人照護理念經由直接照顧、身體評估、觀察、與個案及案妻會談等方式收集資料，並對個案進行生理、心理、靈性、社會層面之整體性評估，確立個案有組織完整性受損、急性疼痛、身體心像紊亂等健康問題。照護期間採無菌技術換藥及水療技術清洗傷口，衛教個案將患肢抬高促進血液循環，使傷口癒合情形加快；運用專業知識、照護技能，協助個案緩解因傷口所引起的疼痛不適；藉由主動關懷、持續性的陪伴、聆聽，鼓勵個案表達內心的感受，並給予支持，使個案漸能正向接受截肢造成的身體外觀改變，出院後重新適應新生活。

This article describes the nursing experiences of taking care of a 32- year-old male patient in a total of 29% of the body 2(nd) to 3(rd) degree burns resulting from gas explosion accident. Due to the right lower limb right knee popliteal artery rupture and severe burns, the patient underwent amputations of his right above-knee. During the period (August 1, 2014 ~ August 22, 2014), the writer made use of Holistic Health Care to collect the information through direct nursing, physical assessment, observations, and interview, as well as made an assessment on the patient's physical, psychology, spirit, and social aspect. The primary nursing practices included impaired tissue integrity, acute pain, and body image disturbance. We provided aseptic techniques for wound care and hydrotherapy dressing skills for cleaning the wound. In addition, we used professional knowledge and skills to help soothe the pain caused by wound healing, and educated the patient to lift his limb elevation for promoting blood circulation. With active concern, continuous companionship and listening, we encouraged the patient to express his feelings and provided him with support to accept the appearance change. These measures we took helped the patient to adapt to new life again.