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題名:照護壞死性筋膜炎患者行左肘下截肢之急診護理經驗
書刊名:榮總護理
作者:洪美鳳陳冬蜜練美華周嫚君
作者(外文):Hong, Mei-fengChen, Tung-miLien, Mei-huaChou, Man-chun
出版日期:2017
卷期:34:1
頁次:頁69-77
主題關鍵詞:壞死性筋膜炎截肢身體心像紊亂Necrotizing fasciitisAmputationBody dysmorphic disorder
原始連結:連回原系統網址new window
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  • 被引用次數被引用次數:期刊(0) 博士論文(0) 專書(0) 專書論文(0)
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  • 共同引用共同引用:7
  • 點閱點閱:30
壞死性筋膜炎病程進展迅速,除手術清創甚至截肢外,更造成呼吸衰竭引發死亡。本文探討一位62 歲肝硬化患者,因皮膚紅腫導致壞死性筋膜炎行左肘下截肢之急診照護經驗。筆者於2014 年7 月27 日至30 日,運用Gordon 十一項健康功能型態評估,採直接護理、觀察會談、資料收集及追蹤訪談等方式,收集主、客觀資料加以分析整理,確立個案有健康「疼痛」、「身體心像紊亂」、「呼吸道清除能失效」健康問題。運用耐心、傾聽及陪伴,鼓勵表達和宣洩情緒,瞭解個案心中感受,並偕同家屬共同參與照護活動,重建正向的自我概念,藉此經驗分享在照護壞死性筋膜炎患者時,除維持生命徵象穩定外,更需重視其心理擔憂、截肢後返家照護及社會適應層面的問題。
Necrotizing fasciitis is invariably followed by sudden deterioration with rapid progression. Patients with necrotizing fasciitis, apart from surgical debridement or even amputation, may easily develop respiratory failure and eventually die. This paper explores the experience of emergency nursing care for a 62-year-old male patient with cirrhosis. The patient had necrotizing fasciitis due to skin swelling and rashes; his left arm required amputation below the elbow. From July 27 to 30, 2014, the researcher used Gordon's 11 functional health patterns to perform direct nursing, observations, interviews, data collection, and track interviews. Analysis and rearrangement of the subjective and objective information that was collected confirmed that the patient had health problems of pain, body dysmorphic disorder, and failure of respiratory tract clearance function. Listening to the patient and accompanying him with patience, the researcher encouraged him to express and vent his emotions. Having understood the patient's feelings, the researcher encouraged his family members to join the nursing and caring activities, and the patient gradually faced and accepted the fact that his arm needed to be amputated. Through this experience, the researcher would like to share with other nursing staff that when nursing patients with necrotizing fasciitis, we need to not only maintain the stability of the patient's vital signs but also pay attention to other problems that the patient might be experiencing such as psychological concerns, home care after amputation, discharge from hospital, and adaptation to society. We should assist patients in rebuilding their confidence in life, and enable them to redevelop a positive attitude toward human life.
期刊論文
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2.巫美惠、王美惠、鄭秀容(20120900)。照顧一位機械損傷右上肢截肢手術病患之護理經驗。榮總護理,29(3),310-316。new window  延伸查詢new window
3.吳曉芸、伍碧琦(20111200)。照顧一位壞死性筋膜炎患者面對截肢後之護理經驗。長庚護理,22(4)=76,518-528。new window  延伸查詢new window
4.Taviloglu, K.、Yanar, H.(2007)。Necrotizing fasciitis: Strategies for diagnosis and management。World Journal of Emergency Surgery,2(19),1-3。  new window
5.劉金珍、林虹良(20120800)。感染海洋弧菌的危險因子與相關護理。高雄護理雜誌,29(2),40-48。  延伸查詢new window
6.謝孟娜(2012)。運用護理指導技巧增進一位壞死性筋膜炎患者傷口照護能力之護理經驗。領導護理,13(4),70-80。  延伸查詢new window
7.李荷思、洪世欣、張芳瑜、高淑雰(20121200)。一位臉部壞死性筋膜炎接受補皮手術病人的照護經驗。榮總護理,29(4),426-433。new window  延伸查詢new window
8.王姵雅、林佳蓉、余美嬅(2014)。一位左膝下截肢個案護理經驗。領導護理,15(3),29-40。  延伸查詢new window
9.吳曉芸、伍碧琦、翁瑞英(20120600)。照顧一位海洋弧菌感染導致壞死性筋膜炎患者之護理經驗。長庚護理,23(2)=78,256-267。new window  延伸查詢new window
10.林怡萱(20120300)。照顧一位海洋弧菌感染併發壞死性筋膜炎個案之加護護理經驗。榮總護理,29(1),95-103。new window  延伸查詢new window
11.林秉毅、吳宥信、林涵威、唐宗凡、胡廣煜、曾建福、郭英雄(20120900)。口腔癌引發頸部壞死性筋膜炎合併肺結核--病例報告。臺灣口腔顎面外科學會雜誌,23(3),213-224。  延伸查詢new window
12.楊佳儒、李慧琦、林佑樺(20101200)。一位雙腳截肢併有壞死性筋膜炎手術後之個案照顧經驗。領導護理,11(3),83-94。  延伸查詢new window
13.Karkas, A.、Chahine, K.、Schmerber, S.、Brichon, P. Y.、Righini, C. A.(2010)。Optimal treatment of cervical necrotizing fasciitis associated with descending necrotizing mediastinitis。British Journal of Surgery,97(4),609-615。  new window
14.Magel, D. C.(2008)。The nurse's role in managing necrotizing fasciitis。Association of Perioperative Registered Nurses Journal,88(6),977-982。  new window
 
 
 
 
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