照顧一位脫襪性損傷及合併永久性造瘻口病人的護理經驗

Nursing Experience of Caring for a Patient With a Degloving Injury and Permanent Colostomy

10.6142/VGHN.202212_39(4).0011

劉怡秀(Yi-Hsiu Liu)；張議文(I-Wen Chang)

脫襪性損傷 ； 造瘻口 ； 身體心像紊亂 ； 羅氏適應理論 ； degloving injury ； colostomy ； body image distortion ； Roy's theory

榮總護理

39卷4期（2022 / 12 / 01）

430 - 436

繁體中文

本文探討一位因車禍導致右臀至右足踝脫襪性損傷及合併永久性結腸造瘻口病人之護理經驗。照護期間為2018年4月12日至5月24日。病人因面臨身體結構及外觀之重大改變，須重新自我調適，同時生活起居完全依賴他人照護，故運用羅氏適應理論，以傾聽、觀察、查閱病歷、會談、身體評估及直接參與照護過程進行收集資料。在完整評估後，健康問題有知識缺失、自我照顧能力缺失、身體功能活動障礙、身體心像紊亂等。護理照護期間，運用主動關懷、正向言語、情緒支持、鼓勵及陪伴，建立病人與家屬對傷口及造瘻口正確認知與照護觀念，使病人從無法面對造口到正向接納，出院後亦能持續自我照護，儘早回歸工作崗位。期盼藉此護理經驗，提供同儕照顧類似案例之參考。

This article describes our experience in providing nursing care from April 12 to May 24, 2018, to a patient with a degloving injury and permanent colostomy. The patient was in a severe car accident, which resulted in a degloving injury from his right hip to his right ankle, with tendon exposure, fracture of the left pubis, open dislocation of the right Choprart joint, and fracture of the fifth metatarsal bone. The patient experienced a major shift in his outlook and required trauma support. We collected and assessed relevant data using Roy's theory. The nursing process included direct care, observation, physical examination, and an empathy interview. The following physical and psychological health-related problems were identified: knowledge deficiency, self-care deficiency, physical function disorder, and disturbed body image. The nursing care provided to facilitate recovery involved maintaining a positive attitude, encouraging the patient, listening to him, understanding his concerns, and providing emotional support to the patient and his family. After comprehensive treatments, surgeries, and nursing care, the patient accepted his wounds and colostomy and discussed recovery with his health-care providers. The patient and his wife also learned about the self-care required for colostomy. After discharge, he was able to return daily life. Our experience may serve as a reference for nurses attending patients with a degloving injury.

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