照顧一位壞死性筋膜炎患者面對截肢後之護理經驗

Nursing Experience of a Patient with Necrotic Fasciitis after Amputation

壞死性筋膜炎若引發全身毒性需要截肢時，會讓患者面對突如其來身體改變，會造成身、心失衡的情緒反應。本文描述一位中年男性糖尿病患者，因傷口癒合不佳併發壞死性筋膜炎，在截肢術後除了承受傷口疼痛外，更面臨永久性肢體殘缺，其內心衝擊的護理經驗。筆者於2009年2月25日至3月8日護理期間，運用羅氏適應模式進行整體性評估，透過直接護理、觀察、身體評估、筆談等方式收集資料，發現個案有呼吸道清除功能失效、疼痛、身體心像紊亂、焦慮與情境性低自尊等護理問題。照顧初期優先處理傷口的疼痛，利用截肢照片與用手觸摸患肢等漸進方式，讓個案能瞭解並正視自己身體外觀的改變，在情緒低落的衝擊期給予足夠的時間哀悼失去的肢體，引導家屬共同參與照護活動，透過自然情境的關懷與互動來連結親情網絡，讓其漸漸能面對並接受截肢的事實，克服疾病所帶來的衝擊並重新適應生活。希望藉此照護經驗提供護理人員在面對截肢患者照護時，不僅滿足其生理需求更應該注重截肢後心理衝擊的護理獨特性。

Necrotizing fasciitis can cause systemic sepsis. If amputation is required, the patient will usually face sudden changes to their body and a physical and mental imbalance of emotions. This article describes the nursing experience of a middle aged male with Diabetes Mellitus with infection caused by right leg wound, resulting in causing necrotizing fasciitis that required amputation. After the amputation, the patient had to adjust to the recurring pain and permanent physical disabilities, which caused mental health problems. Information was collected via physical examination, observation, handwritten interviews, direct nursing and chart review from February 25, 2009 to March 08, 2009. Roy’s Adaptation Model for complete evaluation was used, revealing that the patient had ineffective airway clearance, wound pain, disturbed body image, anxiety and low self-esteem. The first priority was to relieve his pain. Sufficient time was given to mourn the loss of his leg while the patient was encouraged to physically touch and observe the amputation area in an effort to adjust to the altered body appearance. The patient’s family was asked to participate in care activities through natural care situations and interaction with kinship networks, allowing them to gradually accept the amputation and overcome the impact of the disease. It is hoped that through this nursing experience the staff can focus on the unique psychological impact of post-amputation care while addressing the physical and medical needs.