一位巨大肝癌病人手術前後之護理經驗

Nursing care experience of a huge hepatocellular carcinoma patient over the Pre and Post Operative Period

鄭亞芸(Ya-Yun JHENG) ； 蘇淑女(Shu-Nu SU)

《彰化護理》 24卷2期 (2017/06) Pp. 60-72

https://doi.org/10.6647/CN.24.02.12

摘要

本文主要敘述照護一位巨大肝癌病人接受手術引發生理、心理相關問題之護理過程，護理期間為2014年9月19日至9月27日，藉由實際照護、會談、觀察及身體評估等方式收集資料，運用羅氏適應模式進行整體性評估，確立病人有焦慮、急性疼痛、潛在危險性感染、知識缺失（特定的）等健康問題。在護理過程中，筆者與個案建立良好的護病關係，陪伴及傾聽，針對個案健康問題，給予個別性的護理措施及心理支持，降低個案面對此重大手術事件所產生的焦慮；提供手術相關護理指導，幫助個案正確瞭解治療過程及術後相關照護注意事項，解決個案擔憂問題；針對疼痛處置，除了適當的止痛藥物外，教導放鬆技巧及轉移注意力等方式，減輕傷口疼痛不適；指導病人出院後正確換藥技巧及辨識傷口感染徵象，達到良好傷口自我照護。在給予整體性及連續性的照護下，促進其身、心健康，並期望藉由本篇的護理經驗分享，提供日後照護此類病人之護理師參考。

關鍵字

巨大肝癌 ； 焦慮 ； 急性疼痛

並列摘要

This paper describe the care of a huge hepatocellular carcinoma patients undergoing surgery caused physiological and psychological issues related to the nursing process. The period of nursing care was from Sep 19 to Sep 27, 2014. The Roy's adapation model was used for assessment, actual care, meetings, observation. The results indicate that the patient had nursing problems including anxiety, acute pain, potentially dangerous infections and deficiency of knowledge. In the period of providing nursing care, the author was able to established a relationship build on trust with patient, to provide individual measures of nursing care and mental support to reduce the patient's anxiety of surgery. To provide nursing instruction for correctly post-operation education and assist with resolution of problems. Practicing accordance with pain management, in addition to appropriate analgesic drugs, teaching the relaxation skills and other ways to divert for better pain control. Provide health education of wound care knowledge and skills for patient's home care. This experience provided nursed with a reference for caring similar patients in the future.

並列關鍵字

Hepatocellular carcinoma ； anxiety ； acute pain

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。

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。

蔡佩真、陳淑芬(2015)．照護一位乙狀結腸癌併肝轉移病人接受肝腫瘤切除術後之護理經驗．馬偕護理雜誌，9(1)，66-75。

梁嘉德(2008)．肝癌．當代醫學，35(12)，940-942。

任秀如、陳瑛瑛(2008)．預防手術部位感染之實證策略．感染控制雜誌，18(4)，233-239。