照顧一位肝內膽管癌手術病人之護理經驗

本篇報告敘述照護一位56歲接受肝內膽管癌手術病人之護理經驗。筆者於2018年3月28日至4月6日，運用Gorden十一項健康功能型態整體評估，透過直接護理、會談、傾聽等技巧收集資料，確立個案有急性疼痛、現存性感染及焦慮等護理問題。護理過程中，與個案及家屬建立信任關係，除了監測其生理變化外，並提供足夠的心理支持及護理衛教，讓個案及家屬能正確瞭解此疾病過程及自我照顧方式和相關注意事項。術後教導緩解傷口疼痛技巧、舒適的臥位、分散注意力及適當連續性的止痛藥物，減輕疼痛；衛教洗手、身上管路避免拉扯、與醫師討論不必要管路盡早移除，預防感染。臨床發現，癌症個案接受手術都會產生焦慮等常見護理問題，建議在門診即轉介給心理治療或關懷師諮詢，以減輕個案能面對手術及處理焦慮情緒，本院有肝癌個案管理師也建議能在個案第一次看門診時評估是否收案，以利後續追蹤疾病治療計劃，因恢復健康是臨床醫護人員共同的責任目標。

關鍵字

膽管癌；疼痛；焦慮

並列摘要

This report describes the care experience of a 56-year-old patient undergoing intrahepatic cholangiocarcinoma surgery. From March 28th to April 6th, 2018, the author used Gorden's eleven health assessments to collect data through direct care, interviews, listening and other techniques to establish acute pain, current infection and anxiety. In the process of nursing, it is important to establish trust with the case and family members, monitor their physiological changes, and provide adequate psychological support and nursing education, so that the case and family can correctly understand the disease process and self-care methods. Postoperative care training includes relieving wound pain skills, posturing comfortable lying position, distracting, taking appropriate continuity of analgesic drug to relieves pains; washing hands, preventing tube incidents, discussing with the doctors for removing unnecessary drainage to prevent infection. From clinical experience, we can find one thing, that patients after surgical have common nursing problems such as anxiety. It is recommended to refer to a psychotherapy or caregiver consultation at the clinic, to reduce the number of cases that can face surgery and deal with anxiety, the hospital's liver cancer case manager also suggested that it can be assessed at the first visit to the clinic, To facilitate the implementation of the program, Because restorative is a common responsibility of clinical health care.