學齡期病童使用葉克膜治療導致截肢之護理經驗

Nursing Experience for A School Age Child post Amputation due to Complication of Extra-Corporeal Membrane Oxygenation

本文是探討一位學齡期病童因呼吸道感染引發病毒性心肌炎，使用葉克膜治療導致末梢循環壞死行截肢術後的護理經驗。照護期間自2014年7月17日至2014年8月7日，筆者以觀察、會談、身體評估等方式收集資料，運用羅氏適應模式理論為評估架構，確立個案有急性疼痛、身體活動功能障礙、身體心像紊亂及情境性低自尊等護理問題。藉由疼痛評估、配合肌肉按摩及復健運動，教導漸進式轉位、使用輔具、穿衣及進食等活動，鼓勵表達內心感受，醫療團隊與家屬建立良好支持系統，使個案能以正向的態度面對截肢的事實，由依賴他人逐漸恢復獨立自主活動，進而達到良好的生活品質。建議台灣應設立殘障兒童家庭扶助中心，以提供整合性的照護。

This manuscript reports a nursing experience of caring for a pediatric patient post- amputation surgery, which was secondary to peripheral limb gangrenea complication of the application of extra-corporeal membrane oxygenation for viral myocarditis. From July 17 to August 7, 2014, the author collected data through patient observation, interview and physical assessment. With Roche's adaptation model for assessment structure, the identified patient problems were acute pain, physical dysfunction, body image disturbance, and situational low self-esteem. The interventions included muscle massage and rehabilitation exercise with pain assessment, progressive position change with supportive equipment, clothing and eating, etc. He was encouraged to express his internal feelings. The medical team built a good supportive relationship with his family to help the patient positively face the amputation. The patient could live independently gradually without depending on others and further achieve better quality of life. The author suggests a family support center for disabled children that provides postintegrated care in Taiwan.