一位車禍截肢之中年男性患者之護理經驗

The Experience of Nursing a Middle-aged Patient with an Amputation due to Accident

本文探討一位中年男性因車禍左腳傷口潰瘍導致截肢,術後產生身心及社會調適等障礙之護理經驗。於 2016 年 3 月 13 日至 3 月 27 日照護期間,運用 Gordon 十一項健康功能型態為評估工具,透過會談、身體檢查評估、觀察及傾聽技巧收集資料,整理分析後確立個案有急性疼痛、現存危險性感染、身體心像紊亂及無力感 等護理問題。在護理過程中,提供個別性疼痛控制技巧,配合疼痛評估適當調整止痛劑,緩解疼痛,並利用鏡像治療提供了鏡中反射的幻覺,減輕幻肢痛;嚴格執行 無菌技術執行傷口照護,教導預防感染措施及依醫囑給予抗生素治療,改善感染問題;藉由傾聽、主動關懷,鼓勵個案說出心中感受,鼓勵家屬參與治療過程,協助 個案了解及適應此疾病帶來之巨大改變,使個案適當調適身體心像的改變;運用家庭支持及靈性力量,協助個案調適無力感,提升自我照顧能力及提升自我價值,適 應截肢的生活。

 

This article explores the experience of nursing care for a middle-aged man who had an amputation due to a traffic accident and resulting physical, mental, and social adjustment after surgery. The nursing period was from March 13-27, 2016. Data were collected by interviews, physical examination, observation and listening techniques. Gordon’s 11 functional health patterns was used for assessment and formulating nursing problems and patient needs. Existing dangerous infections, physical disorganization and a feeling of powerlessness were the main nursing problems. The nursing process included: providing individual pain control skills, adjusting pain analgesics with pain assessment, relieving individual pain, and using mirror treatment to provide reflection hallucinations in the mirror and reduce phantom limb pain. The patient was taught to strictly use aseptic techniques for wound care, and prevention of infections by antibiotic treatment according to the doctor’s instructions to relieve the infection. The individual was encouraged to participate in the treatment process by listening, actively care, encouraging the individual to participate in the treatment process, and assisting the individual in understanding and adapting to the drastic changes brought about by the surgery. Appropriate changes in the body’s mental image are needed. Family support and spiritual strength can help patients adjust to power- lessness, improve self-care ability and self-value, and adapt to amputation.