一位葡萄球菌燙傷皮膚症候群病童之護理經驗

Nursing Care Experience of Caring a Sick Child with Staphylococcal Scalded Skin Syndrome

本篇個案報告是描述一位罹患葡萄球菌燒燙皮膚症候群病童之護理經驗，護理期間為2019年5月9日至2019年5月16日，運用整體性健康評估，以觀察、傾聽等方式，確立個案的健康問題包括：皮膚完整性受損／毒素引發表皮性脫皮、急性疼痛／皮膚脫皮紅腫有關、照顧者角色緊張／與對葡萄球菌燒燙皮膚症候群的症狀不了解及無照顧經驗有關。經由跨團隊討論並依據文獻建議，開放性傷口照護並使用嬰兒輻射加溫治療床維持個案體溫，以提供個別性皮膚傷口措施，控制感染促進皮膚傷口癒合；給予安撫奶嘴及寧握護理，降低病童疼痛情形；鼓勵家屬參與照護過程，認識個案身上皮膚的變化，增加父母對病程的了解，以減輕案父母焦慮及提升返家後照護之信心。建議可製作罕見疾病衛教指導內容及辦理在職教育，增設照顧皮膚傷口認識之課程與舉辦跨領域團隊討論會，增進照護的品質，期望藉此護理經驗，提供護理同仁日後臨床照護之參考。

This report outlines the nursing experience of caring for a child diagnosed with Staphylococcal Scalded Skin Syndrome (SSSS). The nursing period extended from May 9, 2019, to May 16, 2019. SSSS is a bacterial toxin-mediated skin disorder characterized by widespread peeling skin, primarily affecting young children. Utilizing integrated health assessment skills, along with effective observation and listening, we identified several health problems in this child, including impaired skin integrity due to toxic epidermal peeling, acute pain related to erythroderma and peeling, caregivers' anxiety stemming from inexperience in caring and a lack of awareness about the disease. Drawing on literature recommendations and interdisciplinary team discussions, we recognized that essential measures for promoting skin wound healing included open wound care, utilizing an infant's radiant warmer to maintain body temperature, providing individualized wound healing interventions, and infection control. To alleviate pain in the child, we suggested the use of a soother and containment. Encouraging family members to actively participate in the caregiving process and comprehend the changes in the patient's body skin helped parents understand the disease course, thereby alleviating their anxiety and boosting confidence in home care after discharge. To enhance quality care, we developed health education materials and caregiving standards for various rare diseases. In addition, we conducted in-service educational courses on skin wound care and organized interdisciplinary team discussions. This nursing experience is offered as a reference for clinical staff caring for patients facing similar situations.