一位食道靜脈曲張反覆出血患者之護理經驗

The Nursing Experience of Caring for a Patient with Recurrent Esophageal Variceal Hemorrhage

本文係描述一位肝硬化患者併發食道靜脈曲張反覆出血的照護經驗。食道靜脈曲張破裂出血是肝硬化危及生命的併發症，當破裂出血時其死亡率高達30-50%，其嚴重程度是不容小靦的。個案住院過程中，因害怕反覆食道靜脈出血造成的死亡威脅，與縈繞著兄長過去罹病的負面經驗，逐漸質疑自我角色且因生活照顧能力減退，造成心靈上的壓力。筆者運用實際照護、觀察及會談等方式收集資料，以Gordon十一項健康功能型態進行評估，確立護理問題為體溫過高·組織灌流改變：腸胄、無望感、個人因應能力失調·照顧期聞為2014年12月1日至12月8日，在照護過程中，針對個別性生提供照護措施，主動適時陪伴和給予心理支持，澄清疑慮增強正向的信念，肯定自我存在價值及角色認同，加強疾病相關衛教，為回到家中有更好的生活品質做準備。建議機構建立肝硬化患者併發食道靜脈曲張出血的照護準則，促進病患健康管理及持續性追蹤。期盼本文照護經驗可以提供給臨床工作同仁之參考。

This paper describes the experience of taking care for a patient with cirrhosis experiencing recurrent esophageal variceal hemorrhage. Esophageal variceal hemorrhage is cirrhosis with life-threatening complications when the bleeding rate is up to 30%-50% and the severity cannot be underestimated. The death threaten-ing of recurrent hemorrhage, the negative expe-riences of the patient's brother with the same disease, and doubt of his ability to care for himself have become stressors to the patient. Directing care, observation and therapeutic conversation were used to collect information according to the Gordon's 11 Functional Health Patterns. The nursing problems includes hyper-thermia, ineffective gastrointestinal perfusion, hopelessness and ineffective individual coping. Nursing care starts from 1, December, 2014 to 8, December, 2014. The nursing care experi-ences revealed that to care for patients with cirrhosis experiencing recurrent esophagal variceal hemorrhage, not only to provide individual nursing care, but also to accompany and to give the patient psychological support. In order to have a better quality of life after discharge from the hospital, strengthening their healthcare knowledge and skills, their doubts should be clarified to enhance positive beliefs, affirmation of self-existence and role recognition. It is suggested that to have better care principles for the patient with esophageal variceal hemor-rhage to impprove the patients' health. The experience provides references to the nurses who care the patients with the same or similar conditions.