照護一位糖尿病血液透析病人面臨截肢之護理經驗

A Nursing Experience of Caring for a Diabetes Hemodialysis Patient Facing Amputation

本報告描述一位糖尿病行血液透析且因足部傷口感染而需執行左腿膝下截肢之個案，因恐懼截肢後會面臨身體功能受損而排斥手術之護理經驗。照顧期間為2014 年3 月13 日至4 月22 日，利用Gordon 十一項健康功能型態評估，藉由會談、護理、觀察及傾聽技巧收集資料，確立的健康問題包括：一、組織完整性受損／與左下肢手術傷口有關；二、疼痛-截肢傷口／與糖尿病足截肢有關；三、身體心像紊亂／與無法接受截肢的事實有關。在護理過程中，藉由與個案建立良好護病關係，並經由已行截肢之透析病友及尋求跨團隊復健師、營養師之介入，共同協助個案度過截肢後生理、心理及社會之衝擊危機，使其在截肢術後的生理及心理層面都能得到正向的適應，也能享受良好的生活品質，故期望藉由此經驗分享，作為相關案例照護的參考。

This article describes the nursing experience for a diabetes hemodialysis patient whose left leg needed to be amputated below the knee after infection. The patient feared the physical impairment and objected to the amputation surgery. From March 13 to April 22, 2014, Gordon’s 11 functional health patterns were used to collect information through direct care, observation, medical records and interviews. Identified problems included impaired tissue integrity linked to the surgical wound in the lower left limb, pain due to amputation surgery and body image disturbance/rejection of amputation. The author established a positive relationship based on mutual trust and active care with the patient then introduced the patient to other dialysis patients who had already undergone amputation. The intervention of physiotherapists and dieticians were also introduced to help the patient overcome physical, mental and social problems. The patient eventually adapted positively on a physiological and psychological level to life after amputation surgery, and was able to enjoy a good quality of life. This case report will hopefully provide a useful reference for post-amputation care of dialysis diabetes patients.