照顧一位毒性表皮溶解症個案之護理經驗

Intensive Nursing Experience of Care for a Toxic Epidermal Necrolysis Patient

本文描述一位個案在神內加護病房治療隱球菌腦炎過程中因使用抗生素導致嚴重過敏，引起毒性表皮溶解症之照護經驗，照護期間為2021年7月9日至2021年8月13日，運用Gordon十一項評估作為護理評估之架構，歸納分析個案主要問題有:皮膚完整性受損、急性疼痛、身體心像紊亂等健康問題。因突如其來的嚴重藥物過敏進展至毒性表皮溶解並形成大面積傷口，加上換藥導致個案極大的疼痛，也因皮膚大片損傷導致身體心像改變，讓個案一度產生情緒低落及放棄治療的念頭。筆者藉由跨團隊方式，創造一個類水療環境，提供個案所需之照護，促進皮膚傷口癒合，同時利用藥物及非藥物方式緩解個案在換藥過程中的疼痛不適，並與其建立信任護病關係，在過程中，理解個案靈性依靠，透過宗教及家庭支持系統，促進個案培養正向感受來面對身體變化，重新肯定自我價值；期望藉由此次護理經驗分享，提供照護參考，使個案能夠獲得更完善的照護。

This article presents a case study of a patient who developed severe allergic reactions and toxic epidermal necrolysis (TEN) following antibiotic treatment for cryptococcal meningitis in the intensive care unit, with care provided from July 9 to August 13, 2021. Using Gordon's Functional Health Patterns as the framework for nursing assessment, the primary health issues identified included compromised skin integrity, acute pain, and disturbed body image. The rapid onset of a severe drug allergy leading to TEN caused extensive skin wounds and significant pain during dressing changes, resulting in profound physical and emotional distress. The extensive skin damage also altered the patient’s body image, contributing to sadness and thoughts of abandoning treatment. A multidisciplinary approach was implemented to create a spa-like environment that promoted wound healing and pain relief through both pharmacological and non-pharmacological interventions. A trusting nurse-patient relationship was established, with attention to the patient’s spiritual needs, supported by religious and family networks, encouraging the development of a positive attitude toward bodily changes and reaffirmation of self-worth. By sharing this nursing experience, the author aims to provide a reference for delivering more comprehensive and holistic care to patients facing similar challenges.