一位肝臟移植病人術後之加護護理經驗

The Nursing Experience of Caring for A Liver Transplant Recipient in A Intensive Care Unit

罹患肝炎病人部分衍生成肝臟疾病末期，而肝臟移植手術提昇肝臟疾病末期病人長期生存的機會，但接受肝移植術後的病人對於護理人員密切監測及照護的技能卻是挑戰，急須迫切提昇的。因此，本文主旨描述一位接受肝臟移植的病人因手術、侵入性管路、使用免疫抑制劑而增加感染的機率、疼痛及對手術不了解產生害怕之加護經驗。筆者於照護期間自2013 年3 月21 日至同月25 日，運用Gordon十一項功能性健康模式進行整體性評估，發現個案有潛在危險性感染、疼痛及焦慮三個主要護理問題。在護理過程中，筆者與個案建立良好護病關係，藉由醫療團隊提供肝臟移植的正確資訊及術後自我照護方法，鼓勵情緒表達及家人支持，使個案焦慮程度由21 分降到14 分，並且能自我調適。另一方面落實術後預防感染的防護措施，無菌技術之傷口照護及教導放鬆技巧，使個案轉出加護病房前無感染發生，且傷口疼痛指數由8 分降至2 分，並持續門診追蹤治療。藉由此次照護經驗，建議加護病房護理人員除了注重病人生理照護外，也能深入了解病人心理層面及家屬的需求，以提昇病人照護品質。

Liver transplantation is offered to patients in the terminal stage of liver disease to enhance their long-term survival and the quality of life. Liver transplantation is currently the most widely recognized therapeutic method with high success rates. This case study described nursing care for a liver transplant recipient whose chances of infection, postoperative wound pain, and anxiety were increased due to surgery, invasive tubes used, and the administration of immunosuppressive drugs. The authors applied Gordons 11 functional health patterns to conduct an overall assessment from March 21st, 2013 to March 25th, 2013. The client was found to have three major nursing problems, namely, potential infection, pain, and anxiety. During the nursing process, the author played the role of a supporter, caregiver, and teacher and established a good nursingpatient relationship with the client and his family. The medical teams provision of liver transplant related clinical skills and knowledge of treatment, the patients expression of emotions, and having family support contributed to decrease the client’s anxiety level from 21 points to 14 points, and the client managed to make self-adjustment. On the other hand, the postoperative protection and prevention of infection, and pain were implemented, while the aseptic wound care and relaxation techniques were imparted to ensure the case transferred out of the ICU without occurrences of infections. The clients pain index also decreased from 8 points to 2 points, while outpatient clinical follow-up continued. This nursing experience was provided to clinical nurses as a guide to help them reduce patients pain and better understand patients mental status, thereby improving the quality of care.