- 期刊
肝硬化合併頑固性腹水病人之護理經驗
The Nursing Experience of a Patient with Liver Cirrhosis and Refractory Ascites
摘要
本文描述一位肝硬化合併頑固性腹水病人，因疾病缺乏控制感而焦慮之護理經驗，筆者自2017年11月29日至2018年01月02日護理期間，藉由觀察、身體評估及會談等方式進行資料收集，運用Gordon十一項健康評估工具，歸納出體液容積過量、體溫過高及焦慮等護理問題，護理過程中教導個案及案妻飲食管理原則，並密切監測體重、腹圍及輸出入量，維持體液平衡緩解腹脹不適，保持皮膚完整性，並提供體溫過高之發冷期及發熱期照護，降低感染合併症的發生，另外透過傾聽、主動關懷，與個案建立信任的治療性人際關係，運用陪伴、放鬆技巧、介紹病友經驗分享，醫療團隊舉辦治療計畫說明會以降低其焦慮，個案自我照顧能力及意願也逐漸提升，希望藉此提供護理人員參考。
並列摘要
This article concerns the nursing experience in taking care of a patient with liver cirrhosis and refractory ascites who suffered from uncontrollable disease progression and feelings of anxiety. During the period from Nov 29, 2017, to Jan 2, 2018, the data was collected through observation, physical examination and conversation, using the method of ＂Gordon's 11 Function Health Patterns＂ system, where several health problems and nursing issues were identified including excessive fluid possibly related to impairment of liver regulatory mechanisms leading to fluid retention, hyperthermia possibly related to spontaneous bacterial peritonitis, and anxiety related to uncontrollable feelings toward the disease. In the care process, in addition to medical treatment to alleviate physical discomfort, health education was introduced to increase patient self-control including dietary management, and daily monitoring of body weight, abdominal circumference and skin integrity to maintain body fluid balance to relieve bloating discomfort. Knowledge to recognize hyperthermia was provided with different care required during chills and fever to reduce the incidence of infection comorbidities; additionally, listening and active nursing care established a therapeutic interpersonal relationship with the patient, and with further provision to the patient of relaxation techniques, access to other patients sharing their experiences and attendance in an interprofessional treatment conference, all helped reduce the patient's anxiety. It is hoped this nursing experience could provide a useful reference for other staff.
參考文獻
延伸閱讀
- 陳琳嬿、王璟璇（2007）。一位肝硬化合併食道靜脈瘤出血病患的護理經驗。長庚護理，18(2)，266-274。https://doi.org/10.6386/CGN.200706_18(2).0015
- 陳思佳、梁靜祝（1999）。肝性腹水病患的護理。護理雜誌，46(2)，94-100。https://doi.org/10.6224/JN.46.2.94
- 林育儀、江以薰、吳莉喻（2020）。一位肝性腹水及肝性腦病變病人的加護護理經驗。高雄護理雜誌，37(2)，132-143。https://doi.org/10.6692/KJN.202008_37(2).0012
- 褚淑芸、徐淑芬（2015）。一位肝硬化併發腹水及肝性胸水病人之加護護理經驗。馬偕護理雜誌，9(1)，42-53。https://doi.org/10.29415/JMKN.201501_9(1).0004
- 林羿伶、吳淑芬、陸椿梅、傅家芸（2011）。The Nursing Experience of a Liver Cirrhosis Patient with Hepatic Encephalopathy and Ascites。新臺北護理期刊，13(2)，115-124。https://doi.org/10.6540/NTJN.2011.2.012