- 期刊
照護一位酒精性肝硬化行肝臟移植術後病人之加護經驗
Experience of Caring for a Patient with Alcoholic Liver Cirrhosis in Intensive Care Unit Following Liver Transplantation
摘要
本文描述一位60歲男性因酒精性肝硬化行肝臟移植手術後在加護病房之護理經驗。護理期間2020年9月22日至9月28日，筆者運用Gordon十一項功能性健康型態評估，藉由觀察、身體評估、結構及非結構性會談等方式進行資料收集，確立病人健康問題為一、急性疼痛／與術後傷口及管路留置壓迫刺激有關；二、呼吸道清除功能失效／與術後傷口不敢用力咳嗽及氣管內管留置痰液不易自咳有關；三、營養狀況改變：少於身體所需／與疾病和術後消化吸收不良有關；四、照顧者角色緊張／與對病程進展不確定性及缺乏照顧技巧有關等四項健康問題。護理過程中提供整體與持續性照護，運用護理獨特功能及技巧以減輕身體疼痛不適、藉由早期肺部復健護理活動及採漸進式呼吸訓練，促進有效性咳痰能力進而成功脫離呼吸器、透過營養照護計畫提升腸胃道蠕動及增加吸收力、運用關懷及共同參與學習照護技巧，增進照顧者自信心其降低不安及緊張。建議設立跨專業的肝臟移植團隊及專責個管師，可提供完善的諮詢及照護，提升術後照護品質，期望藉此護理經驗分享，提供同仁照護參考。
並列摘要
This report details the experience of caring for a male patient with alcoholic liver cirrhosis in an intensive care unit (ICU) from September 22 to 28, 2020, after liver transplantation. Gordon 11 Functional Health Patterns was applied in this study, and the data were collected through observation, physical assessment, and structured and unstructured interviews. The health problems were categorized into three major types: acute pain and issues related to the postoperative wound, pressure irritation from the indwelling catheter, failure of airway clearance and issues related to the postoperative wounds that caused the patient to avoid coughing hard, the indwelling of the endotracheal tube, the difficulty of coughing sputum, changed nutritional status (nutrition is less than required), postoperative dyspepsia, nervousness of the care givers, uncertainty of the patient's progress, and a lack of caring skills. Comprehensive and continuous care should be provided during the nursing process, and nursing skills should be applied to relieve physical pain for patients. Through early lung rehabilitation, nursing activities, and progressive breathing training, patients should be able to effectively develop expectoration ability and hence be successfully weaned off the ventilator; nutritional care programs should improve gastrointestinal motility and increase absorption. Care givers would be more confident and less nervous when providing care and comfort and should learn caring skills. A transdisciplinary team including liver transplantation professionals should be formed, and a case manager should be assigned for providing consultation and care services to enhance the quality of postoperative care and for sharing related care experience with the staff for further reference.