一位酒精性肝硬化病人肝臟移植術後急性混亂之護理經驗

A Nursing Experience of an Alcoholic Liver Cirrhosis Patient Suffering from Acute Confusion After Liver Transplant

吳晨綠(Chen-Lu Wu) ； 王湞雅(Chen-Ya Wang) ； 蔡佩臻(Pei-Chen Tsai)

《志為護理-慈濟護理雜誌》 18卷2期 (2019/04) Pp. 118-128

摘要

本文描述一位54歲個案因酒精性肝硬化接受肝臟移植手術的照護經驗。筆者於照護期間2017年5月10日至6月1日運用羅氏適應模式評估，確立個案主要健康問題有：急性混亂、體液容積過量、焦慮。在護理過程中，彈性增加會客時間以提供個案安全感、調整病室內燈光以增加定向感、與醫師討論增加輔助藥物促進夜間睡眠等策略，順利度過手術後的急性混亂階段。與營養師、醫師共同討論調節個案水份攝入與排出，並給予合適的飲食衛教，改善個案體液容積過量狀態。再則，協助個案了解移植術後的病程進展、耐心回答個案反覆性疑問及指導放鬆技巧，成功降低焦慮程度，最終使個案順利轉至普通病房，並逐漸恢復健康。

關鍵字

肝臟移植 ； 羅氏適應模式 ； 急性混亂

並列摘要

This article described a nursing experience of a 54-year-old patient with alcoholic liver cirrhosis undergoing liver transplant. From May 10^(th) to June 1^(st), 2017, the authors conducted a comprehensive evaluation of the patient by applying attentive listening, written communication and Roy's adaptation model, confirming major health problems including acute confusion, fluid volume excess and anxiety. To address the patient's post-operational acute confusion, the nursing interventions we provided during the nursing process included flexible meeting time to bring the patient a sense of security, adjustment to the ward lighting to regain usual reality orientation, and discussions with the physician on administering complementary medicine to improve night-time sleep. For the fluid volume excess, we planned with physicians and dietitians on nursing interventions including monitoring the balance of the patient's fluid intake and output, and educating the patient and the family the importance of proper nutrition and diet modification. Furthermore, to reduce the patient's level of anxiety, we educated the patient and the family about the course of post-transplantation, patiently answered the patient's repeatedly doubts and instructed the patient with relaxation techniques. Ultimately, the patient was successfully transferred to the general ward and continues to recover gradually.

並列關鍵字

acute confusion ； liver transplant ； Roy's adaptation model

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