照顧一位肝癌等待阿爾庇式第二階段手術之護理經驗

A Nursing Experience of a Liver Cancer Patient Waiting the ALPPS Second Surgery

陳柍圻(Yang-Chi Chen) ； 陳俞君(Yu-Chun Chen)

《彰化護理》 27卷2期 (2020/06) Pp. 82-94

https://doi.org/10.6647/CN.202006_27(2).0012

摘要

本文描述一位因肝癌需廣泛性肝切除行阿爾庇式等待第二階段手術之照護經驗。照護期間自2016年03月05日至03月24日，運用Gordon十一項健康功能型態作為評估工具，經由觀察、會談、傾聽、身體評估及病歷查閱等方式收集資料，發現個案除手術後生理症狀不適外，另因等待第二階段治療過程的無法預測，使得生理及心理面臨極大衝擊及壓力，進而確立個案有急性疼痛、營養狀態改變：少於身體所需及焦慮之健康問題，於護理過程中提供個案疼痛控制技巧，改善術後疼痛；遵照營養指引給予適當飲食調配及衛教，以增加飲食進食量；透過建立良好的護病關係，給予心理支持並增加正向能量以調適心理壓力，最後得以如期進行第二階段手術並成功順利出院，期望藉此護理經驗能做為日後照護此類個案之參考。

關鍵字

肝癌 ； 阿爾庇式手術 ； 急性疼痛 ； 營養 ； 焦慮

並列摘要

This paper concerns the experience of providing nursing care to a patient requiring major hepatic resection and waiting for the second stage operation in the Associating Liver Partition and Portal vein ligation for Staged hepatectomy(ALPPS) approach. Care period 2016/3/5-2016/3/24. Gordon 11 functional health patterns was used as the instrument for nursing assessment of the patient. Information regarding the patient was collected through observation, conversation, listening, physical assessment, and reviewing patient records. It was found that the patient developed post-surgery physical discomfort, and showed apparent signs of psychological impact and stress due to the unpredictability of the second stage treatment, specifically acute pain, malnutrition, and anxiety, among others. The nursing process focused on teaching the patient techniques to control pain and alleviate post-surgery trauma, as well as following nutritional guidelines and hygienic tutorials to increase the patient's food intake. The nursing process allowed care providers to establish a good relationship with the patient, enabling care providers to give mental support and moderate the patient's mental stress through positive input. The patient successfully underwent second stage treatment and was eventually discharged from the hospital. This care experience as a reference for clinical work.

並列關鍵字

Liver cancer ； ALPPS ； Acute pain ； Nutrition ； Anxiety

參考文獻

明金蓮、洪曉佩（2011）‧急性疼痛評估與症狀護理‧源遠護理，5（1），11-16。doi：10.6530/YYN.2011.5(1).02

林韋君、袁素娟、黃秀梨（2010）‧營養狀況改變及護理‧領導護理，11（3），21-32。

徐莞雲、陳筱瑀（2008）‧焦慮的概念分析‧志為護理，7（3），65-70。

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‧領導護理，16（4），11-20。

陳怡呈、蔡淑玲、蔡昌雄、黃珊（2012）‧肝硬化合併腹水病患之調適經驗‧新臺北護理期刊，14（2），13-21。doi：10.6540/NTJN.2012.2.002