一位肝性腦病變及腹水病患之護理經驗

The Nursing Experience of a Liver Cirrhosis Patient with Hepatic Encephalopathy and Ascites

本文是描述一位53歲肝硬化合併肝性腦病變及腹水女性病患，面對身體、心理及社會層面受損之照護經驗。於2008年12月20曰至2009年1月15日照護期間筆者藉由仔細觀察、直接照護、良好的溝通及會談技巧收集資料，並運用羅氏適應模式來評估病患，進而資料分析歸納，以確立病患的健康問題為：思想過程改變、體液容積過量、身體心像紊亂及知識缺失。在護理過程中，筆者運用同理心、關懷箏方式建立良好的護病關係及運用適當的護理措施，解決其身體不適症狀；亦透過專業及適切性護理，協助個案進行正向的身體心像行為’鼓勵表達感受，使其能達到心理調適，並適時提供相關疾病知識與護理指導箏，幫助個案調整生活型態、增進生理及心理健康，進而增進自我照顧能力，維持生活品質。This article discusses the nursing care experience of a 53-year-old female who suffered from liver cirrhosis complicated with hepatic encephalopathy, ascites and how she dealt with physical, psychological and social difficulties. A systemic evaluation using Roy's adaptation model was performed during the caring period from December 20, 2008 to January 15, 2009. Four nursing problems were identified, including thought processes altered, fluid volume excess, and disturbance in body image and knowledge deficit. During the nursing period, we used empathy and continuing nursing care to build up good relations and provided professional and appropriate physiologic nursing care to relieve the patient’s discomfort. The author helped the patient to have a positive attitude and adapt to the physical and mental impacts of the disease, encouraged her to express her feelings, and provided her with the nursing instruction about the treatment of the disease. We helped the patient to adjust the life style, to enhance physiological and psychogenic health, to take care of herself, and to maintain a living quality.