一位因粉塵爆炸導致嚴重燒傷病人之照護經驗

Nursing Care Experience of a Severe Dust Explosion Burn Patient

10.6386/CGN.201809_29(3).0010

陳建璋(Chien-Chang Chen)；梁鈞瑜(Chun-Yu Liang)；張乃文(Nai-Wen Chang)

急性呼吸窘迫 ； 身體心像紊亂 ； 活動功能障礙 ； 粉塵爆炸傷相關性燒傷 ； acute respiratory distress ； body image disturbance ； physical mobility impairment ； dust explosion

長庚護理

29卷3期（2018 / 09 / 01）

442 - 455

繁體中文

本報告描述一位因粉塵爆炸造成全身80%體表面積2-3度嚴重燒傷個案之照護經驗。於2015年07月01日至10月24日照護時間，透過直接照護、觀察及會談等方式，運用同理心和關懷建立良好護病關係，以Gordon 11項健康功能型態為評估架構，收集並分析個案資料，確定其健康問題為：「氣體交換障礙」、「體溫過高」、「身體活動功能障礙」與「身體心像紊亂」。急性期協助液體復甦、人工氣道置入、呼吸機使用，解決肺部氣體交換障礙問題，並積極預防嚴重燒傷之合併症及感染，以維持生命徵象穩定；恢復期藉由主動關懷、傾聽及心理支持鼓勵個案渡過艱難之復健過程，利用燒傷功能性評估量表增進個案復健動力，持續給予心理支持及協助，使其恢復身體活動功能，克服身體心像紊亂之恐懼，恢復活動功能及社交活動，期盼透過照護嚴重燒傷個案之報告分享作為未來臨床照護之參考。

This report described the nursing care experience of a 27-year-old male with 2-3 degree burn on 80% body surface area due to dust explosion. Data were collected from July 1 to October 24, 2015, through direct care, observation, and interview. During this period, the author established a good relationship with the patient by empathy, solicitude, and used Gordon 11 functional health assessment tool to assess the patient and collect information to determine the patient's health problems. The health problems included impaired gas exchange, hyperthermia, physical mobility impairment, and body image disturbance. At the acute stage, the author settled the problem of gas exchange impairment by fluid resuscitation, artificial airway placement, and ventilator usage. Moreover, the author worked constructively on preventing the occurrence of burn complications, controlling infection of the burn wound, and stabilizing patient's vital signs. At the recovery stage, the author encouraged the patient's motivation in restoring physical mobility by using the functional assessment scale for burn patient. In addition, the author used caring and psychological support to help patient overcome the problem of body image disturbance and resume functional activities and social relationships. The author shares this particular nursing care experience of a severe burn patient as a reference for future clinical care.

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