一位威爾森氏症行肝臟移植後排斥復發病患之護理經驗

The Nursing Experience of a Post-Transplant Patient with Wilson’s Disease Suffering from Recurrent Liver Graft Rejection

本文運用Gordon十一項功能性健康型態評估，探討一位威爾森氏症行肝臟移植八年個案，因排斥復發致肝功能損傷，面臨可能須再次換肝的身心衝擊之護理經驗。護理期間2009年3月6日至4月22日，藉由直接照護、身體評估、觀察會談、鼓勵個案說出心中感受，以進行資料收集。確立個案有營養狀況改變少於身體所需、身體心像紊亂、無望感等健康問題，筆者藉由提供疾病照護知識改善個案營養狀況，不斷的肯定與鼓勵使個案接受疾病復發與走出身體外觀改變的陰影，真誠關懷態度接納其情緒反應，以宗教滿足靈性需求，並發展新的因應能力，面對無望感。期望藉此照護經驗的分享，能提供護理同仁日後面對復發個案照護時，不僅提供生理上的照護，更能重視心理層面問題，以達完整性的照護品質。

This case report described the physical and psychosocial impacts of a Wilson’s disease patient who had liver transplantation eight years ago. The patient was evaluated using the Gordon’s functional health as pattern assessment tool. The patient was recently hospitalized for recurrent rejection and severely impaired hepatic functions that probably required liver transplantation. The study period was from March 6 to April 22, 2009. The methods used included data collection from nursing records, physical examinations, observations, and direct communication. The problems were identified as imbalanced nutrition less than body requirements, disturbed body image, and a sense of hopelessness. Through the provision of relevant health information to improve the patient’s nutritional status as well as repeated reassurance and encouragement to facilitate the patient’s acceptance of her disease status, a bond between the patient and the nursing staff was thus established. The results showed that a patient’s positive attitude toward treatment can be attained through appropriate emotional support and reassurance by nursing staff.