照護一位肺臟移植術後使用葉克膜治療併發截肢病人之護理經驗

Nursing Experience in Caring a Patient Receiving Right Lower Limb Amputation for Complication of Extracorporeal Life Support After Lung Transplantation

10.6692/KJN.202408_41(2).0006

陳慧玲(Hui-Ling Chen)；林青瑜(Cing-Yu Lin)

肺臟移植 ； 截肢 ； 身體心像紊亂 ； lung transplantation ； limb amputation ； body image disturbance

高雄護理雜誌

41卷2期（2024 / 08 / 01）

60 - 70

繁體中文;英文

本文描述37歲男性因接觸二氧化矽，罹患塵肺症接受肺臟移植手術，術後因接受葉克膜輔助治療，導致右膝下截肢，照護期間2021年1月10日至2月18日，作者以Gordon十一項健康功能型態為評估工具，藉由直接護理、身體評估、觀察會談、病歷查閱及訪談方式收集病人資料，發現有急性疼痛、身體活動功能障礙及身體心像紊亂問題。運用非藥物疼痛控制技巧減輕不適，增加復健意願；與復健師擬訂計畫，維持健肢肌力及關節活動度，恢復患肢最大功能；術後肺部功能預後良好，但因疾病發展導致截肢，受到重大衝擊，引導面對身體及截肢之改變，順利重返生活與社會活動，建議住院期間讓病人了解義肢及接受，恢復日常生活，冀望藉由此護理經驗，作為照護相似病人參考。

This article describes a nursing experience in caring a 37-year-old male patient who received right leg amputation due to complication of Extracorporeal Life Support after lung transplantation for pneumoconiosis. The nursing period lasted from January 1 to February 18, 2021. By daily observation, physical examinations, and chart reviews, the authors collected the patient's information and applied Gordon 11 functional health patterns to evaluate his problems in nursing care. The major problems identified were acute pain, movement disability, and body image disturbance. The authors taught the patient the non-pharmacological methods for pain relief during movement to increase his willingness to rehabilitate. The rehabilitation practitioner also developed an individualized rehabilitation program for him with an aim to maintain the muscle strength and joint mobility of the affected limb. Although the postoperative pulmonary recovery was adequate, the limb amputation struck the patient physically and emotionally. It is recommended that the medical team should prepare the amputated patient to accommodate walking and living with a prosthesis during hospitalization and encourage them to have a positive attitude toward their new body image. With these preparations, amputated patients could resume their social functions more smoothly after hospital discharge. The authors hoped to provide our colleagues with a valuable reference for in caring for similar patients in the future.

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