照顧一位因肝臟撕裂傷合併休克個案之加護護理經驗

Nursing Experiences While Treating a Client Suffering from Hepatic Laceration and Shock in an ICU

本文敘述一位因車禍導致肝臟嚴重撕裂傷、腹腔大量出血而急轉加護病房密切照顧，卻因創傷嚴重無法進行外科手術，採內科療法之重症個案護理經驗。護理期間自民國97年4月25日至97年6月2日，筆者透過觀察、紙筆會談、身體評估方式蒐集主、客觀資料，藉由Gorden十一項健康功能型態對個案進行護理評估，確立個案五個主要之護理問題有：體液容積缺失、死亡焦慮、營養不均衡：少於身體需要、身體活動功能障礙和急性疼痛。在照護過程中，筆者注意到因車禍導致腹部嚴重出血休克的個案，常面臨重症病程急劇性變化及死亡之威脅進而產生焦慮，經由護理人員持續性關懷、解釋、傾聽及家屬之陪伴，增加了個案的信心並減少其焦慮。在急重症醫療加護護理下，穩定個案出血危象，並經由全靜脈腸胃道外營養（TPN）改善個案營養狀態及體力。經各種藥物及非藥物處置減輕疼痛，並提供漸進式肌力訓練活動，增加個案肌肉耐力，使個案能夠漸進式下床並維持功能性活動。個案在加護病房住院三十八天，病情趨於穩定，轉至普通病房繼續照顧，並開始其復健之路。

This article describes critical care nursing experiences in terms of medical therapy while treating a post-traumatic patient suffering from severe liver laceration and massive intra-abdominal bleeding. The nursing period extended from April 25 to June 2 in 2008. The authors used Gordon’s Eleven Functional Health Patterns as a framework and collected objective and subjective information by observation, interview and physical examination. We found five major nursing problems associated with this posttraumatic patient: dehydration, anxiety about death, malnutrition, functional disability, and acute pain. Throughout the course of treatment, we noticed that the client, who had suffered from severe post-traumatic intra-abdominal bleeding and hemorrhagic shock, was frequently experiencing anxiety about the rapid changes in the course of the illness and the threat of death. We tried to ease and reduce the patient’s anxiety by continuous care, careful listening and by family visits. With critical care nursing, we solved the bleeding crisis, improved his nutrition by total parenteral nutrition, eased his pain by medical and psychological support, and provided progressive muscle power training and relaxation skills in order to maintain functional activity. After staying in the ICU for 38 days and after stabilization, he was transferred to a ward for further care and has recovered well.