照護一位65歲活體肝臟捐贈者之護理經驗

Experience of Surgical Ward Nurses in Promoting Quality in Post-operative Patient Care of a 65-year-old Living Liver Donor

劉翔婷(Shiang-Ting Liu) ； 蕭惠祝(Huei-Jhu Siao)

《彰化護理》 26卷2期 (2019/06) Pp. 107-119

https://doi.org/10.6647/CN.201906_26(2).0012

摘要

本篇文章為描述一位65歲中年男性，得知攜手結縭40年妻子因罹患B型肝炎帶原導致末期肝硬化，出現黃疸、腹水、肝性腦病變等症狀且病況危急，急需行肝臟移植手術，兒女併有B型肝炎帶原無法捐贈，而個案已超過60歲合適捐贈之年齡，在肝臟移植小組與個案及子女討論下，個案毅然決定行活體肝臟移植手術。照護期間為2016年10月1日至2016年10月9日。筆者透過直接觀察、會談、傾聽及實際參與照護過程收集資料，並運用羅氏適應模式為評估指引，針對個案生理、心理、靈性及社會層面行整體性評估，發現有焦慮、恐懼及急性疼痛之護理問題。筆者主動提供相關衛教，協助其了解手術過程及可能發生的併發症和照護注意事項，並協助個案與醫師討論其術後治療計畫。透過團隊合作，協助個案渡過術後，解決生理、心理問題恢復其生活品質，完成攜手與妻共度日子的心願。

關鍵字

活體肝臟捐贈 ； 焦慮 ； 恐懼

並列摘要

The purpose of this study was to report the nursing care experiences of a 65-year-old male who underwent live donor partial hepatectomy as a donor. The patient's wife who has suffered from hepatitis B carrier related end-stage liver cirrhosis complicated with jaundice, ascites, and hepatic encephalopathy was in urgent need of liver transplantation. All their children were hepatitis B carriers which contraindicated them from being a donor. With our upper donor age limit being 60 years, after a throughout evaluation by our liver transplantation team and discussions with the patient and family members, the patient decided to undergo living liver donation. The period of nursing care was from October 1, 2016 to October 9, 2016. The author collected data through direct observation, interviews, listening and actual participation in the caring process. The Roy's adaptation model was used as a guide to assess the physical, psychological, spiritual and social aspects of the patient. He was further evaluated to see if the patient suffered from anxiety, fear or post-operative acute pain. Moreover, possible operative complications and care precautions related to surgical procedure were informed in layman's term. We also participated in the bedside rounding and were involved in the postoperative treatment plans with the physicians. Through multidisciplinary teamwork, we were able to assist the patient to overcome not just the postoperative discomforts, but also to solve physiological and psychological issues which further restored the patient's quality of life.

並列關鍵字

Living donor liver transplant ； anxiety ； fear

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