照顧一位海洋弧菌感染導致壞死性筋膜炎患者之護理經驗

Nursing Experience of a Patient with Vibriovulnificus Infection and Necrotic Fasciitis

糖尿病患者傷口如果感染海洋弧菌，容易引發壞死性筋膜炎，嚴重時可能併發敗血症而死亡。本文描述一位67歲糖尿病患者，因右手大拇指不慎被魚刺扎傷導致壞死性筋膜炎，併發敗血性休克與急性腎衰竭之護理經驗。筆者於2010年11月22日至12月10日護理期間，運用羅氏適應模式透過直接護理、觀察、身體評估、筆談等方式進行整體性評估，確立個案有疼痛、組織完整性受損、焦慮與無力感等護理問題。護理過程優先處理傷口疼痛，提供傷口照護、預防感染及減少周圍組織受損，讓傷口能逐漸癒合，透過主動關懷、陪伴，提供疾病相關資訊來建立互信關係，鼓勵表達其需求與內心感受，藉此降低焦慮情緒，鼓勵參與傷口換藥過程、透過參與式照護提升自我控制的能力，介紹類似疾病之病友分享經歷疾病的心路歷程與因應方式。強化家人情感之脈絡增強個案的信心與希望，幫助個案重新面對罹病後不同的自我。藉此經驗分享面對壞死性筋膜炎患者，除了滿足疾病威脅造成的生理不適外，更需重視其擔憂成為家人負擔之心理困擾。

Diabetic patients with wounds infected by vibriovulnificus are prone to necrotizing fasciitis, severe sepsis, and even death. This article describes the nursing experience of a female 67-year-old diabetes mellitus patient with necrotizing fasciitis caused by a right thumb stick injury with a fish bone, leading to septic shock and acute renal failure complications. Information was collected via physical examination, observation, handwritten interviews, direct nursing, and chart review from November 22, 2010 to December 10, 2010. Roy's Adaptation Model for complete evaluation was used. Problems identified included wound pain, impaired tissue integrity, anxiety, and feelings of powerlessness. Through active wound care, companionship, and provision of disease-related information while establishing trust, infections were prevented and damage to the surrounding tissue was reduced. The patient was encouraged to express her needs and feelings, thereby decreasing anxiety and physical discomfort. She was also encouraged to participate in the wound dressing process. The patient was introduced to similar disease sufferers to share common experiences and coping strategies, as well as strengthen the feelings of camaraderie and self-confidence. By learning from experiences of other patients with necrotizing fasciitis, the patient was able to address her psychological distress of becoming family burdens and also to overcome the discomfort of the disease.