照顧一位猛暴性肝衰竭病人之護理經驗

Nursing Experience of a Patient with Fulminant Hepatic Failure

本文藉由照顧一位B型肝炎帶原者因為免疫力下降導致猛暴性肝衰竭，合併上腸胃道出血及肝性腦病變，甚至危及生命需接受加護照顧的護理過程。護理期間為92年8月9日至92年8月19日，筆者以Gordon十一項健康型態做整體性評估，確立其護理問題有：體液容積缺失、急性混亂、睡眠型態紊亂、焦慮等四項。針對這些問題，依據相關文獻，提供適合的護理措施，密切監測生命徵象，適當補充體液及維持電解質平衡，穩定血流動力；並運用主動關懷、傾聽溝通、人性化護理及家庭壓力模式護理等技巧，提供專業知識及諮詢，減輕其內心的焦慮，以協助其渡過急性期生理及心理的危機。期望藉此照護經驗的分享，提供護理同仁在面對猛暴性肝衰竭病人照護時，在給予生理上的照護外，亦能重視心理層面，達成全面性的照護品質。

This article described the nursing experience of caring for an immune compromised patient who suffered from fulminant hepatic failure complicated with upper gastrointestinal bleeding and encephalopathy. The condition was life threatening and required intensive care. From August 9 to August 19, 2003, the author applied Gordon 11 functional health assessment guides, and confirmed that the patient had the following nursing problems: fluid volume deficit, acute confusion, sleep pattern disturbance, and anxiety. Appropriate nursing cares were provided to alleviate the problems. The author closely monitored the patient’s vital signs, provided sufficient body fluid, maintained electrolyte balance, and kept hemodynamic stable. The author also used empathy, support, humanized solicitude, and family stress model nursing to relieve patient’s inner anxiety and support the patient during acute physical and psychological stages. This article shared the nursing experience of caring patients with fulminate hepatic failure. Both psychological and physiological problems should be dealt with at the same time in order to achieve optimum care.