運用身體心像照護模式於史蒂芬強森症候群個案之加護經驗

Nursing Experience Involving the Use of Body Image Care Model for a Patient with Stevens-Johnson Syndrome in Intensive Care Unit

陳怡婷(Yi-Ting Chen)；劉欣怡(Hsin-I Liu)；章雅茜(Ya-Chien Chang)

身體心像照護模式 ； 史蒂芬強森症候群 ； 身體像改變 ； Body image care model ； Stevens-Johnson syndrome ； Body-image change

若瑟醫護雜誌

17卷1期（2023 / 06 / 01）

57 - 69

繁體中文;英文

史蒂芬強森症候群（Stevens-Johnson Syndrome, SJS）為一種藥物導致皮膚廣泛脫落症狀之症候群，壞死及黏膜潰瘍導致體液流失、體溫調節失調及代謝率增加，嚴重易引起身體多重器官衰竭。本文旨在描述一位感冒就醫服用藥物後藥物不良反應，造成嚴重的皮膚與黏膜受損之史蒂芬強森症候群之重症照護過程。護理期間為2019年08月14日至08月24日，運用身體心像照護模式，透過傾聽、會談與身體評估收集資料，發現有急性疼痛、口腔黏膜完整性受損、皮膚及黏膜完整性受損與身體心像改變之健康問題，臨床照護除緩解疼痛、預防感染、提供皮膚及口腔黏膜損傷照護，運用溝通技巧、同理支持及鼓勵表達內心感受，協助個案調適疾病變化過程，建立正向身體心像。期望藉此經驗提供此類個案之臨床照護參考。

Stevens-Johnson Syndrome (SJS) is caused by medication and results in extensive peeling of the skin, necrosis, mucosal ulcer and other related symptoms. It can severely impact several organs of the body including: lungs, liver, kidney, and gastrointestinal and blood systems. It can result in fluid loss, dysregulation of body temperature, and increased metabolic rate. In burn patients, severe reactions such as extensive skin necrosis can occur. This article describes a nursing experience caring for a patient with SJS caused by adverse medication reactions and severe skin and mucosal damage after taking medication for a cold. During the nursing period (August 14 to 24, 2019), the body image care model was used to collect data. Through active listening, conversations, and physical evaluations, it was found that there was acute pain, oral mucosal damage, skin mucosal damage, and health problems affected by body image changes. In addition to relieving pain, preventing and controlling infection, providing skin and oral mucosal injury care, it was also important to use communication skills to support and encourage the patient to express their inner thoughts and feelings. These measures helped the patient better adjust to changes caused by the disease and establish a positive body image. It is hoped that this experience can help provide a reference for clinical care of similar patients in the future.

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