失明糖尿病個案接受截肢手術之護理經驗－個案報告

Nursing Experience on Caring a Blind Diabetic Patient with Below-Knee Amputation: A Case Report

10.6200/TCMJ.2014.11.2.09

林佳琪(Chia-Chi Lin)；蔡衣帆(Yi-Fan Tsai)；楊式辰(Shih-Chen Yang)

截肢 ； 現存性感染 ； 急性疼痛 ； 知識缺失 ； 身體心像紊亂 ； Amputation ； existing infection ； Knowledge deficit ； Body image disturbance

北市醫學雜誌

11卷2期（2014 / 06 / 01）

206 - 218

繁體中文

本文旨在報告一位70歲糖尿病病足個案，因傷口感染再接受右膝下截肢手術之護理經驗。護理期間自2011年4月27日至5月18日，運用Gordon十一項健康功能型態及觀察、會談與身體檢查收集資料。結果發現個案有（一）現存性感染與糖尿病病足清瘡傷口呈紫黑色、滲血有關；（二）急性疼痛與接受截肢手術傷口有關；（三）知識缺失與個案及案女缺乏截肢照護資訊來源有關；（四）身體心像紊亂與右膝下截肢之主要健康問題。經抗生素控制；教導正確執行傷口照護；使用止痛藥、搖高床尾抬高患肢；以「截肢術後自我照顧評量表」評量截肢照顧認知，利用截肢術後護理指導手冊圖示及實際示教等護理措施，終使截肢後傷口未發生感染；疼痛由9分降至2分；「截肢術後自我照顧評量表」評分由10分提升至100分，個案也能正向的面對殘肢的事實。期許此照護經驗能做為護理同仁日後照護相關個案之參考。

This report describes the caring experience of a 70 years old female with diabetic foot disease who had right below-knee amputation due to infection. Data were collected by using the Gordon's Function Health Patterns, as well as clinical observations, interviews and physical examinations. The following results were found: (1) Existing infection and debridement of the wound showed purple and black tissues, appearing related to bleeding; (2) acute pain related to amputation wound; (3) knowledge deficiency and lack of treatment information sources (本句內容與中文內容有差別); (4) disturbance of body image and primary health problem of the amputation. The following actions were carried out: (1) use of antibiotic to control the inflammation; (2) guiding with correct wound care; (3) use of painkiller 15 minutes before dressing change; (4) raised patient's feet by raising the bottom of the bed to reduce tension and pain; (5) use of Self Care Assessment on Amputation to evaluate amputation care knowledge, and (6) use of figure-based amputation care guidebook and practical samples for health education. As a result, the amputation wound remained uninfected during the hospitalization period. The pain score was reduced from 9 to 2 points whereas the score of Self Care Assessment on Amputation increased from 10 to 100 points. Also, the patient appeared to face the amputated limb with more positive attitude. This experience may be referenced for caring related patients.