協助ㄧ位糖尿病血液透析病人面臨再次截肢後身體心像紊亂之護理經驗

Providing assistance to a diabetic hemodialysis patient dealing with body image disturbance arising from a second amputation

本文描述一位血液透析個案面臨再次截肢後身體心像紊亂之護理經驗。個案在接受治療期間因左腳糖尿病足傷口感染壞死，於2013 年11 月5 日行左膝下截肢，隔年右足底水泡綠膿桿菌感染，於2014 年12 月8 日行右膝下截肢，一年內雙腿先後截肢，面對身體功能受損及心理衝擊。筆者於2014 年12 月8 日至2015 年1 月15 日照護期間，運用直接護理、觀察會談、傾聽、病歷查閱等方式收集資料，依據Gordon 十一項功能性健康型態評估個案，並確立個案有：（1）急性疼痛；（2）身體心像紊亂；（3）自我照顧能力缺失之護理問題。筆者藉由主動關懷與個案建立信任關係，提供個別性護理措施，包括按摩、深呼吸、轉移注意力等放鬆技巧，並配合藥物使用以緩解疼痛；引導家屬共同參與照護活動，藉由家屬及團體的鼓勵與支持，幫助個案接受身體結構功能的改變，使個案更快適應截肢後生活，重拾自信；指導肌肉訓練、殘肢上下床搬運方法及輔助工具的使用，以促進恢復日常生活功能，回歸社會。期望藉由此護理經驗的分享提供日後護理同仁照顧類似個案之參考。

 

This paper describes the case of a hemodialysis patient who suffered from body image disturbance after undergoing a second amputation. The patient underwent a transtibial amputation of the left leg on November 5, 2013 due to a diabetic foot infection that developed into necrosis during the patient’s treatment period. In the following year, a blister on the patient’s right sole was infected by Pseudomonas aeruginosa, which led to the patient undergoing a below-knee amputation of the right leg on December 8, 2014. The author of this paper utilized a variety of methods (such as direct nursing, observations and interviews, listening, and case reviews) to gather data between December 8-January 15, 2014 to assess the patient’s condition using Gordon’s 11 functional health patterns model. The assessment established that the patient was suffering from: 1. acute pain; 2. body image disturbance; 3. self-care deficit. To help alleviate the suffering of the patient, who was taking medication at that time, the author established a strong relationship of trust with him via demonstrating active concern, and implemented individualized nursing care measures (which included relaxation techniques such as massages, deep breathing, and attention diversion). The patient’s family members were encouraged to participate in patient care activities, and through the encouragement and support of the patient’s family members, the patient was able to accept the changes to his body and physical functions, and thus adapt to life as an amputee and regain his confidence more quickly. The patient was also provided with guidance on how he can carry out strength training, get on and off a bed, and utilize assistive devices, allowing him to regain his ability to perform daily activities and return to society. It is hoped that the sharing of this nursing experience will provide our nursing colleagues with a reference for similar cases that might occur in the future.