一位血液透析病人罹患周邊動脈阻塞疾病併發截肢之護理經驗

A Nursing Experience of a Hemodialysis Patient with Peripheral Arterial Occlusive Disease Complicated with Amputation

10.53106/172674042023122201004

李子瑜(Zih-Yu Li)；林嘉慧(Chia-Hui Lin)；黃羿華(Yi-Hua Huang)

血液透析 ； 周邊動脈阻塞疾病 ； 截肢 ； emodialysis ； peripheral arterial occlusive disease ； amputation

臺灣腎臟護理學會雜誌

22卷1期（2023 / 12 / 01）

42 - 55

繁體中文;英文

本文敘述一位血液透析個案合併周邊動脈阻塞疾病導致傷口惡化面臨左膝下截肢，截肢後的外觀及結構改變，造成其心理巨大的衝擊與震撼。護理期間於2021年4月8日至2021年6月30日，運用Gordon十一項健康功能型態進行整體評估，藉由會談、護理、觀察及傾聽技巧收集資料，確立個案有營養不均衡：少於身體需要、身體活動功能障礙及身體心像紊亂之健康問題。照護期間利用蛋白質替換食譜QR code，採循序漸進的飲食計畫改善營養狀態，教導家屬截肢後產生的身體功能障礙和負面情緒之照護技巧，運用主動關懷、陪伴、引導其表達內心感受、鼓勵家人參與陪伴支持。照顧截肢病人在面對此段挫敗的人生經歷，醫療人員應積極協助面對不可逆的合併症，並提升其自我照護知識與能力，重建正向態度找回自我控制權迎向新生活。

This article describes the nursing experience of a hemodialysis patient with PAOD receiving below-knee amputation. The appearance and structural changes of the amputated limb had a huge psychological impact and shock. The nursing period was from April 8 to June 30, 2021, using Gordon's 11 Functional Health Patterns were to collect information through direct care, observation, medical records and interviews. Identified problems included inadequate nutrition, impaired physical mobility and body image disturbance. During the nursing process, provided individualized nursing, designed protein exchange recipe guided by QR code, monitored his nutritional status and taught his family after amputation care skill. The author performed active caring and accompanied him to guide him express his deep mind feelings and to encourage his family to give support and accompany. Medical professionals should actively help amputees face irreversible complications, enhance their knowledge and self-care skills, rebuild positive attitudes, regain self-control and move forward to a new life.

1. 何嘉莉,吳麗敏(2019)。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。臺灣腎臟護理學會雜誌，18(1)，76-89。
   連結：
2. Ali, S.,Haider, S. K. F.(2017).Psychological adjustment to amputation: variations on the bases of sex, age and cause of limb loss.Journal of Ayub Medical College Abbottabad,29(2),303-307.
3. Bandyk, D. F.(2018).The diabetic foot: pathophysiology, evaluation, and treatment.Seminars in Vascular Surgery,31(2-4),43-48.
4. Boaz, M.,Azoulay, O.,Kaufman-Shriqui, V.,Weinstein, T.(2021).Status of nutrition in hemodialysis patients survey (SNIPS): malnutrition risk by diabetes status.Diabetic Medicine,38(6),e14543.
5. Crawford, A.,Harris, H.(2016).Caring for adults with impaired physical mobility.Nursing,46(12),36-41.
6. Firnhaber, J. M.,Powell, C. S.(2019).Lower extremity peripheral artery disease: diagnosis and treatment.American Family Physician,99(6),362-369.
7. Hunter, S. W.,Batchelor, F.,Hill, K. D.,Hill, A. M.,Mackintosh, S.,Payne, M.(2017).Risk factors for falls in people with a lower limb amputation: A systematic review.Physical Medicine and Rehabilitation,9(2),170-180.
8. Kaminski, M. R.,Raspovic, A.,McMahon, L. P.,Lambert, K. A.,Erbas, B.,Mount, P. F.,Kerr, P. G.,Landorf, K. B.(2017).Factors associated with foot ulceration and amputation in adults on dialysis: A crosssectional observational study.BMC Nephrol,18(1),293.
9. Moore, Z. E.,Corcoran, M. A.,Patton, D.(2020).Nutritional interventions for treating foot ulcers in people with diabetes.Cochrane Database Systematic Reviews,7(7),CD011378.
10. Morley, R. L.,Sharma, A.,Horsch, A. D.,Hinchliffe, R. J.(2018).Peripheral artery disease.British Medical Journal,360,j5842.
11. Papadopoulou, S. K.(2020).Sarcopenia: a contemporary health problem among older adult populations.Nutrients,12(5),1293.
12. Simsek, N.,Ozturk, G. K.,Nahya, Z. N.(2020).The mental health of individuals with post-traumatic lower limb amputation: A qualitative study.Journal of Patient Experience,7(6),1665-1670.
13. United states renal disease system (2020, January 6). Cardiovascular disease in patients with ESRD. Annual Data Report. https://adr.usrds.org/2020/endstage-renal-disease/8-cardiovasculardisease-in-patients-with-esrd
14. 吳紅蓮(2017)。透析病人改善營養不良的重要性－營養諮詢與營養介入之應用。腎臟與透析，29(1)，49-53。
15. 陳沂名,顏旭霆(2021)。腳痛腳麻未必只是退化，有可能是周邊動脈阻塞了。健康世界，539，30-33。