獨居老人因肝硬化引發個人因應能力失調之護理經驗

The Nursing Experience of an Elderly Man Living Alone with Ineffective Individual Coping Induced by Liver Cirrhosis Combined with Esophageal Varices Hemorrhage

本文是描述照護一位72 歲男性獨居老人因感受肝硬化對生命之威脅，引發因應能力失調之經驗。個案自民國94 年至98 年間曾因肝硬化及其合併症共住院35次，並接受食道靜脈曲張結紮術7 次。98 年10 月16 日再次因肝硬化併發食道靜脈曲張出血，由急診入院。護理期間為民國98 年10 月16 日至26 日於內科病房。以 Gordon 十一項健康功能評估進行護理評估，藉由觀察、會談、身體評估等方法收集資料，發現個案主要的護理問題為：體液容積缺失、潛在危險性損傷- 跌倒、個人因應能力失調等。在恢復期以預防再次出血和日常生活照護為護理重點，協助個案建立因應疾病之飲食和生活作息。也針對個案因為獨居而擔心發病時無人送醫，予協助辦理「24 小時緊急救護通報系統」，並連繫社會局社工定期家訪及電訪，來增進居家安全感，而增加個案的因應能力。由此顯示護理人員主動聯絡個案居住社區的資源並轉介追蹤，可以改善個案之健康問題，期望能藉由此次護理經驗的分享，作為護理人員日後照護相關個案之參考。

The aim of this article is to describe a nursing experience with ineffective coping in a 72- year-old elderly man living alone with liver cirrhosis combined esophageal varices. The patient had been hospitalized 35 times due to liver cirrhosis and complications; he has also received esophageal variceal ligation for bleeding from esophageal varices 7 times from 2005 to 2009. The patient was admitted from an emergency room, and was suffering from liver cirrhosis with EV bleeding, combined with symptoms of hematemesis, weakness and sweating on October 16th, 2009. The author collected his information according to Gordon’s 11 Functional Health Patterns Assessment tool through observation, conversation and physical assessment from October 16th to 26th, 2009. The patient’s main nursing problems included fluid volume deficit, risk of injury due to falling down, and ineffective individual coping. The nursing emphasis was to prevent bleeding again and to provide daily life care in order to allow the patient to cope withthe diet and the rhythms of life with disease. In addition, the elderly patient was living alone and worried that no one could rush him to the hospital when he gets sick. The author also helped set up the “24-hour emergency ambulance reporting system” and provided contacts with social workers from the Bureau of Social Affairs to conduct regular visits and telephone interviews to enhance patient’s sense of security and improve the problem of ineffective coping. These results showed that nurses can provide links to community resources to help resolve patients’ problems. This nursing experience can serve as a reference for nursing colleagues engaged in providing similar patient care.