一位睪丸壞死性筋膜炎急性疼痛病人之照護經驗

A Nursing Experience of Caring for a Patient in Acute Pain secondary to Necrotizing Fasciitis of the Testicle

表達疼痛常常需依賴溝通的能力，但重症病人因使用呼吸器及鎮靜藥物或意識改變，無法順利表達。本文旨在探討一位睪丸壞死性筋膜炎急性疼痛之病人，插管期間藉由重症照護疼痛觀察工具（CPOT）評估疼痛程度，並提供藥物及非藥物疼痛緩解措施，且因個案正處於壯年期之40歲男性，術後畢丸外露而出現社交退縮、憂鬱等身體心像紊亂狀態。照護期間為2015年3月10日至3月16日，藉由筆談、觀察等方式收集資料並運用Gordon十一項功能性健康型態進行評估，確立護理問題有：疼痛／與術後傷口及身上管路有關、身體心像紊亂／與睪丸切開傷口之外觀有關、知識缺失／與糖尿病自我照顧認知不足有關。除緩解疼痛，滿足其生理需求外，亦重視其心理層面之壓力，協助案妻在旁陪伴，鼓勵個案並引導其說出內心感受，適時衛教個案自我照護之技巧，終究使得個案順利轉出。期望藉由此篇個案報告，提供日後照護經驗之參考。

Expression of pain usually relies on the ability to communicate. However, critically ill patients cannot easily express their feelings of pain because of the use of a ventilator, administration of sedative medication, or change in mental status. The purpose of this article is to explore the acute pain experience of a patient with necrotic fasciitis of the testicle during intubation. The patient's pain levels were assessed with the Critical-Care Pain Observation Tool (CPOT) for the evaluation of pain relief with pain medication and non-medication interventions. A 40-year-old male patient suffered from social withdrawal, depression, and body image disturbance secondary to testicular exposure after surgery. The caring period was from March 10 to 16, 2015. The author collected data through interview and observation and assessed the patient with the Gordon's 11 Functional Health Patterns Assessment Tool. The identified nursing problems included pain relevant to the operative incision and drainage tubes, body image disturbance related to the appearance of the incision on the testis, and a knowledge deficit about self-care for diabetes. In addition to relieving the patient's pain and attending to his physiological needs, the author cared about the patient's psychological stress. The author assisted the patient's wife in accompanying the patient, encouraged and guided the patient to express his internal feelings, and educated the patient about self-care skills. The patient was successfully transferred out of the unit. The author hopes that this report provides a reference of care experience for nurses who may care for patients with a similar diagnosis in the future.