一位闌尾炎合併化膿性肝膿瘍患者之護理經驗

Nursing Experience of an Appendicitis Patient with Pyogenic Liver Abscess

本篇個案報告是探討一位闌尾炎術後合併化膿性肝膿瘍病患的護理經驗，護理期間為94年4月28日至5月13日。筆者藉由Gordon十一項健康功能評估為工具，運用身體評估、觀察及會談的方式收集資料，在護理期間發現個案出現體溫過高、焦慮、疼痛、潛在危險性感染等四個護理問題。針對其身、心問題提供適當的護理措施，包括發燒的處理及引流管照顧的注意事項，利用心理支持及放鬆技巧減輕個案焦慮及疼痛，給予相關之飲食衛教等。本文期望能提醒護理人員在照護闌尾炎手術患者時，除了減少病患傷口疼痛不適及觀察傷口是否感染外，也應提高警覺，當病患高燒不退及腹痛不止，應考慮是否有發生合併症之可能性。筆者也藉此個案的護理經驗，針對化膿性肝膿瘍作一文獻的整理，使同仁對此疾病有進一步的了解，也呼籲臨床不可輕忽此一常見且不致於有生命威脅的疾病。

This article describes nursing experience of an appendicitis patient with pyogenic liver abscess. The duration of nursing care was between April 28(superscript th), 2005 and May 13(superscript rd), 2005. The methods used for data collection included physical evaluation, observation, and personal interview. Based on Gordon's functional health assessment, the case's health problems included high fever, anxiety, pain, and the potential risk of infection. Based on these problems, the author designed a nursing plan that included management of the fever, attention to and care of drainage, reduction of the patient's anxiety and pain by the use of psychological support and relaxation techniques and the provision of dietary education. By presenting this case report, the author hopes to remind others of the problems that occur when caring for the appendicitis patients. This will help not only to reduce wound pain and/or discomfort and identify wound infection, but also serve to raise vigilance of the possibility of complications. Nurses need to contact the responsible physician when patients have high fever or abdominal pain. In addition, the author broadens this nursing experience with a literature review of pyogenic liver abscess and suggests that clinicians should not give common diseases such as appendicitis a low priority.