一位罹患史蒂芬強森症候群個案之護理經驗

Nursing Experience of a Patient with Stevens- Johnson syndrome

本文探討一位史蒂芬強森症候群男性個案，因痛風發作自行購買成藥服用，出現全身皮膚紅黑色斑塊、水泡及水泡破裂傷口，個案因大面積傷口及換藥，感劇烈疼痛，突如其來的身體變化而無法面對，使個案情緒低落。筆者以Gordon 11項健康功能評估工具，確立「急性疼痛」、「皮膚完整性受損」及「身體心像紊亂」等護理問題，個案全身傷口及換藥疼痛，給予藥物及非藥物護理，幫助個案解決疼痛不適，無菌換藥並引導個案及案妻參與、學習換藥技巧，促進傷口癒合，心理方面，給予傾聽、陪伴、關懷、鼓勵表達內心想法及正向回饋同理情緒，提供各式治療資訊及衛教，醫師、心理師團隊提供協助，並安排親友給予心理支持，協助個案疾病自我調適，勇敢面對自我，回歸健康生活。

This article discusses a case of a man with Stevens-Johnson syndrome, who bought the medicine by himself due to a gout attack. He began to develop red and black patches, blisters, and ruptured wounds on his skin.The man suffered severe pain and sudden physical changes due to the extent of the wound and the dressing change process, which caused he to feel frustrated. The author used Gordon 11 Function Health Patterns as assessment tools, three major health problems were identified, including“Acute Pain”,“Impaired Skin Integrity”and ''Disturbed Body Image''. For the man's systemic wounds and pain during dressing changes, bothmedical and non-drug care were given. In order to solve pain and discomfort, the man underwent changes of the dressing under aseptic methods. Guidance was also issued to the man and his wife to participate in changing the dressing, in order to learn dressing skills and promote wound healing. In terms of psychological healing, attentive listening, companionship, care, encouraging expressions of inner thoughts, as well as positive feedback of empathy, would be beneficial. In addition, the provision of various treatments regarding information and health education, a team of physicians and psychologists to provide assistance, as well as the arrangement for psychological support from relatives and friends to assist the man in self-adjustment to illness, can promote positive self-esteem and a smooth return to a healthy life.