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

10.29494/LN.201612_17(4).0004

邱怡蓉(Yi-Jung Chiu)；李佳欣(Chia-Hsin Li)；馬瑞菊(Jui-Chu Ma)

壞死性筋膜炎 ； 重症照護疼痛觀察工具 ； 疼痛管理 ； 身體心像 ； Gangrene ； Critical-Care Pain Observation Tool ； Pain Management ； Body image

領導護理

17卷4期（2016 / 12 / 01）

33 - 43

繁體中文

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.

1. Cheung, J. P.,Fung, B.,Tang, W. M.,Ip, W. Y.(2009).A review of necrotising fasciitis in the extremities.Hong Kong Medicine,15,44-52.
2. Hsiung, Nai-Huan(2012).Tools for measuring the pain of unconscious patients in critically illness: a literature review.Chinese J. Pain,22(2),52-62.
3. Mock, V.(1993).Body image in women treated for breast cancer.Nursing Research,42(3),153-157.
4. Molon, S. L.,Kobayashi, M.,Holleran, E. A.,Mezey, M.(2005).Assessing pain as a fifth vital sign in long-term care facilities: recommendations from the field.Journal of Gerontological-Nursing,31(3),16-24.
5. 王致善(2006)。網路社會學通訊期刊
6. 行政院衛生福利部(2014).主要死因分析。取自http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no= 2368
7. 吳思賢,陳建華(2010)。淺談糖尿病足。臨床醫學，56(4)，256-258。
8. 林特暐,王維理,李貫廷,楊偉勛,黃國晉(2014)。2014年美國糖尿病學會臨床治療指引摘要。台北醫師公會會刊，58(4)，39-48。
9. 張妙如,黃慈心,謝素英(2012)。穴位按壓對中老年骨性關節病人之身體症狀和心理社會功能成效。長庚護理，23(4)，419-430。
10. 張秀如,余玉眉(2006)。身體觀點-體現與身體心像。護理雜誌，54(3)，77-81。
11. 郭緒東,張天長(2012)。外傷傷口癒合與慢性傷口。家庭醫學與基層醫療，27(12)，414-421。
12. 陳惠君,曾月霞,陳玉敏(2011)。中文版重症照護疼痛觀察工具之效度檢定。護理暨健康照護研究，7(2)，108-116。
13. 詹淑雅,劉芹芳,金繼春(2011)。身體心像紊亂之概念分析。新臺北護理期刊，13(1)，63-72。
14. 蕭采云,謝秀芳(2009)。運用音樂療法減輕骨科術後病患急性疼痛之護理經驗。護理雜誌，56(4)，105-110。

1. 張耀文,范姜玉芬,李淑秋,朱美玲(2023)。照顧一位壞死性筋膜炎個案之護理經驗。長庚護理，34(1)，91-101。
2. 鄭淑華,連敏安(2023)。協助一位年輕型中風個案早期復健之加護經驗。彰化護理，30(1)，120-132。