協助一位糖尿病血液透析病人面臨再次截肢後身體心像紊亂之護理經驗

何嘉莉; 吳麗敏

doi:10.3966/172674042019061801006

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协助一位糖尿病血液透析病人面临再次截肢後身体心像紊乱之护理经验

Providing Assistance to a Diabetic Hemodialysis Patient Dealing with Body Image Disturbance Arising from a Second Amputation

何嘉莉(Chia-Li Ho) ；吴丽敏(Li-Min Wu)

台湾肾脏护理学会杂志； 18 卷 1 期 (2019 / 06 / 01) ， P76 - 89

繁体中文 DOI： 10.3966/172674042019061801006

截肢；急性疼痛；身体心像紊乱；自我照顾能力缺失； amputation ； acute pain ； body image disturbance ； self-care deficit

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摘要 │ 参考文献 (16) │ 被引用文献 (4) │ 国际计量

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This paper describes the case of a hemodialysis patient who suffered from body image disturbance after undergoing a second amputation. The patient underwent a transtibial amputation of the left leg on November 5, 2013 due to a diabetic foot infection that developed into necrosis during the patient's treatment period. In the following year, a blister on the patient's right sole was infected by Pseudomonas aeruginosa, which led to the patient undergoing a below-knee amputation of the right leg on December 8, 2014. The author of this paper utilized a variety of methods (such as direct nursing, observations and interviews, listening, and case reviews) to gather data between December 8-January 15, 2014 to assess the patient's condition using Gordon's 11 functional health patterns model. The assessment established that the patient was suffering from: 1. acute pain; 2. body image disturbance; 3. self-care deficit. To help alleviate the suffering of the patient, who was taking medication at that time, the author established a strong relationship of trust with him via demonstrating active concern, and implemented individualized nursing care measures (which included relaxation techniques such as massages, deep breathing, and attention diversion). The patient's family members were encouraged to participate in patient care activities, and through the encouragement and support of the patient's family members, the patient was able to accept the changes to his body and physical functions, and thus adapt to life as an amputee and regain his confidence more quickly. The patient was also provided with guidance on how he can carry out strength training, get on and off a bed, and utilize assistive devices, allowing him to regain his ability to perform daily activities and return to society. It is hoped that the sharing of this nursing experience will provide our nursing colleagues with a reference for similar cases that might occur in the future.

参考文献 ( 16 ) 〈TOP〉

Archer, K. R.,MacKenzie, E. J.,Castillo, R. C.,Bosse, M. J.,LEAP Study Group(2009).Orthopedic surgeons and physical therapists differ in assessment of need for physical therapy after traumatic lowerextremity injury.Physical therapy,89(12),1337-1349.
Bijur, P. E.,Latimer, C. T.,Gallagher, E. J.(2003).Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department.Academic Emergency Medicine,10(4),390-392.
Breakey, J. W.(1997).Body Image: The Lower-Limb Amputee.JPO: Journal of Prosthetics and Orthotics,9(2),58-66.
Burgoyne, L. L.,Billups, C. A.,Jirón, J. L., Jr,Kaddoum, R. N.,Wright, B. B.,Bikhazi, G. B.,Pereiras, L. A.(2012).Phantom limb pain in young cancer-related amputees: Recent experience at St. Jude Children’s Research Hospital.The Clinical journal of pain,28(3),222-225.
Coffey, L.,Gallagher, P.,Horgan, O.,Desmond, D.,MacLachlan, M.(2009).Psychosocial adjustment to diabetes-related lower limb amputation.Diabetic Medicine,26(10),1063-1067.

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