一位老年患者肝癌手術後出現譫妄之護理經驗

Nursing Experience of Delirium after Liver Cancer Surgery in an Elderly Patient

莊竹君(Jhu-Jyun Jhuang) ； 蘇淑女(Shu-Nu Su)

《彰化護理》 27卷1期 (2020/03) Pp. 74-85

https://doi.org/10.6647/CN.202003_27(1).0010

摘要

本文描述一位84歲男性肝癌手術後出現急性混亂譫妄之護理經驗。筆者於2017年3月25日至4月1日以全責護理方式照顧個案，藉由觀察、會談、身體評估等方式持續收集資料，並運用羅氏適應模式做為評估架構進行整體性評估，確立個案有焦慮、急性疼痛、急性混亂等健康問題。在照護過程中，與個案建立信任關係，給予關懷、鼓勵、傾聽與陪伴，提供術後照護注意事項，針對疼痛問題，持續評估個案疼痛程度，教導轉移注意力減輕疼痛，協助個案減輕焦慮及生理上的不適。於個案混亂期時，採集中護理，安排安全與舒適的環境，提升睡眠品質，重新建立定向感，也建議老年患者入院手術時可安排靠窗床位，讓個案清楚白天與黑夜，幫助個案早日恢復意識，回復正常生活。期望藉由此護理經驗，提供相關照護單位之參考。

關鍵字

肝癌 ； 譫妄 ； 術後疼痛

並列摘要

This article describes a nursing experience of a liver cancer patient who is an 84-years-old man that has an acute confusion after surgery. In 2017, the writer takes a charge of taking care of the patient from 25^(th), March to 1^(st), April. By continuous observation, interviewing and physical assessment to search information, the writer also applies Roy's Adaptation Model as a whole assessment structure which convinces of patient has some healthy problems on anxiety, acute pain and delirium. In the process of taking care of patient, the writer will establish a trust relationship with patient and provide postoperative care precautions. Focusing on painful problems, the writer will evaluate the degree of patient's soreness, teach patient how to divert his attention to release painful and reduce physical discomfort. During the period of acute confusion, the writer takes a concentrated care to take care of patient, and set up a comfortable environment to improve sleeping quality. In order to help the patient to restore consciousness, the writer also can recommend arranging a window bed to the patient when having a surgery, so that the patient can easily return to a normal life. By sharing this nursing experience, it will provide treasure reference for the future.

並列關鍵字

Liver Cancer ； Delirium ； Soreness

參考文獻

王菁莞、林佑樺、李來涼、簡婉儀、陸椿梅(2014)‧探討多媒體護理指導對婦科開腹手術病人術前焦慮之成效‧護理暨健康照護研究，10（3），169-177。

林麗絲、謝佳恩、林惠娟、王思涵、林國華、林佳正、陳堯俐（2014）．肝癌患者經肝葉切除術後譫妄之危險因素．台灣醫學，18（4），390-396。

郭瑞萍、翁靜美、陳金玫（2015）．護理人員在術後疼痛照護中的挑戰．領航護理，16（4），11-20。

陳美如(2017)．肝癌病患的照護．血管醫學防治季刊，28，23-25。

楊鎮嘉、高玉娟（2017）．譫妄症臨床診治．長期照護雜誌，21（2），81-92。