照顧一位外籍勞工斷指接受截肢和皮瓣重建手術之護理經驗

The Nursing Experience of A Foreign Worker with Severed Finger Receiving Amputation And Flap Reconstruction

本文旨在描述一位越南籍勞工，因工作不慎，遭機器壓斷手指及部分手掌，緊急執行截肢手術，之後因傷口癒合不佳而執行清創手術和腹股溝皮瓣手術，所造成的生理及心理衝擊之護理經驗。護理期間自2017年10月31日至11月22日。照護期間運用Gordon十一項健康功能型態為評估架構，確立個案有：急性疼痛、組織完整性受損及焦慮之健康問題。在照護期間，提供緩解疼痛的方法，如：換藥過程動作輕柔、提供轉移注意力、協助患肢抬高以減輕肢體腫脹、依疼痛強度適時給予止痛劑；給予生理食鹽水敷料濕敷傷口，並視情況使用泡棉敷料和親水性敷料，以維持組織在潮濕環境，此外，教導抬高患肢及肢體按摩，以促進血液循環，進而促進傷口癒合；鼓勵個案說出心中的想法及感受，執行各項護理活動前，請案妻翻譯越南語或用手機翻譯軟體，詳細說明目的及過程，以增加個案安全感及控制感，另外，請醫師向個案及案妻解釋相關治療，讓個案瞭解整個照護計畫，並且協助聯絡社工師，申請相關補助及轉介出院後職能復建，以減輕其焦慮。盼藉此經驗能提供護理人員作為日後在照顧類似病患之參考。

This case report describes the nursing experience of a Vietnamese worker, who was accidentally crushing his fingers and part of his palm, so that accept emergency amputation, who dealt with physical symptom and psychological impact. The nursing period was from October 31 to November 22, 2017, according to the data analyzed by the assessment tool of Gordon’s 11 functional health patterns, the result indicated that the patient’s nursing problem including impaired tissue integrity, acute pain, and anxiety. During the period of caring, providing the patient’s pain relief methods, such as changed the dressing gently, distracting the patient’s attention, assisting the affected limb to raise to reduce limb swelling, and also using analgesics according to the intensity of pain. The Normal Saline dressing is applied to the wet wound, and the foam dressing and the hydrocolloid dressing are used as needed to maintain the tissue in a humid environment. In addition, teaching to raise the affected limb and limb massage to promote blood circulation and then promote wound healing. The encourage patients to speak their thoughts and feelings. Before implementing various nursing activities, ask the wife to translate Vietnamese or use mobile phone translation software, detailing the purpose and process to increase the sense of security and self-control. In addition, asking the doctor to explain the relevant treatment to the patient and his wife, so that the patient can understand the entire care plan. Contact the social worker for apply the relevant subsidies and referrals to the occupational rehabilitation after discharge. Apply the above means to alleviate the anxiety of patients. The findings are helpful to serve a reference to other nurses care of similar patients.