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[为一名患有大疱性表皮松解症的新生儿提供伤口护理的护理经验]

[Nursing Experience With Providing Wound Care for a Newborn With Epidermolysis Bullosa].

作者信息

Hsu Hsiao-Hui, Zheng Xin-Yi, Hsu Mei-Yu

机构信息

BSN, RN, Wound Ostomy Continence Nurse, Department of Nursing, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, ROC.

BSN, RN, Tuberculosis Case Manager, Department of Nursing, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, ROC.

出版信息

Hu Li Za Zhi. 2015 Dec;62(6):112-7. doi: 10.6224/JN62.6.112.

Abstract

Epidermolysis bullosa (EB) is a rare hereditary, chromosomal disease of the skin. Life-threatening septicemia may result if appropriate care is not provided to alleviate the extensive skin irritation that is the main symptom of this disease. This case report describes the experience of the author in nursing a wound area on a newborn that was suspected of being caused by EB. This wound area comprised blisters and peeling skin that covered 30% of the entire skin area of the infant. A holistic assessment conducted from December 1st, 2013 to January 7th, 2014 revealed that this large of an area of damage to the skin and mucosa considerably complicated the task of wound care and caused severe pain to the infant. In response to the special needs of this case, our medical team conducted a literature review of wound care for this rare disease. Based on the suggestions of previous empirical studies, nursing measures for the skin, mucosa, and wounds of the newborn were then administered through inter-team cooperation. These actions effectively reduced the pain, controlled the infection, and accelerated wound healing. In addition, progressive contact was used to guide the primary caregivers of the newborn, which alleviated their physical and psychological stresses effectively. The caregivers were educated systematically on wound care and guided to learn techniques for nursing and dressing wounds. Thus, these caregivers were better prepared to continue providing wound care at home. We suggest that healthcare professionals reference empirical studies when providing care to EB newborns during the acute-care period and provide wound care and supportive therapies to control the occurrence of complications using a multidisciplinary team-care model. In addition, social resources should be used effectively in nursing care plans to mitigate the effect of this rare disease on families.

摘要

大疱性表皮松解症(EB)是一种罕见的遗传性染色体皮肤病。如果不提供适当护理以减轻作为该疾病主要症状的广泛皮肤刺激,可能会导致危及生命的败血症。本病例报告描述了作者护理一名疑似由EB引起的新生儿伤口区域的经验。该伤口区域包括水泡和脱皮,覆盖了婴儿整个皮肤面积的30%。2013年12月1日至2014年1月7日进行的全面评估显示,如此大面积的皮肤和黏膜损伤使伤口护理任务相当复杂,并给婴儿带来了剧痛。针对该病例的特殊需求,我们的医疗团队对这种罕见疾病的伤口护理进行了文献综述。基于先前实证研究的建议,然后通过团队间合作对新生儿的皮肤、黏膜和伤口采取了护理措施。这些行动有效减轻了疼痛、控制了感染并加速了伤口愈合。此外,采用渐进接触法指导新生儿的主要照顾者,有效减轻了他们的身心压力。对照顾者进行了伤口护理的系统教育,并指导他们学习伤口护理和换药技术。因此,这些照顾者为在家中继续提供伤口护理做好了更充分的准备。我们建议医疗保健专业人员在急性护理期为EB新生儿提供护理时参考实证研究,并采用多学科团队护理模式提供伤口护理和支持性治疗以控制并发症的发生。此外,应在护理计划中有效利用社会资源,以减轻这种罕见疾病对家庭的影响。

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