照護一位活體肝臟移植手術前行血漿置換病人之加護經驗

Experience of Intensive Care in a Patient with Plasma Exchange before Liver Transplantation

末期肝病患者為挽回生命並獲得良好生活品質的治療方式，只有肝臟移植手術。本文描述協助一位肝癌預接受活體肝臟移植手術個案，因捐贈者血型不相容，初次入住加護病房接受血漿置換術治療，面臨治療過程的疑惑產生極大的不確定感。筆者於 2018 年 5 月 31 日至 6 月 5 日照護期間，以 Gordon 十一項功能性健康型態，採觀察、傾聽、會談、身體評估及直接照護方式收集資料，統整分析後，確立健康問題有焦慮、體液容積過量及潛在危險性感染。運用主動關懷、傾聽、陪伴，建立良好互動關係及提供個別合適性護理，耐心說明疾病症狀、合併症與後續治療處理、降低其焦慮，加強個案對處置治療的瞭解，改善呼吸困難症狀、維持輸出入量水份平衡及飲食衛教，另在急性期，加強侵入性導管置入部位傷口照護，避免傷口感染。透過醫療團隊及家屬資源介入，強化個案支持系統及正向思考，順利度過肝臟移植前準備期。建議日後單位增加術前血漿置換相關資訊衛教手冊及專科性教育，合併共照團隊溝通關懷能力，透過案例討論強化護理同仁評估及介入時機判斷處理能力，讓護理人員日後對此類個案照護更加知悉其技巧。

In order to save lives and obtain good qualities of life for patients with end-stage liver disease, the only treatment is liver transplantation. This study described a pre-liver transplant patient’s of liver cancer that facing great uncertainty doubt of the nursing treatment process, because donor's blood type is incompatible and first admitted to intensive care unit for plasma exchange treatment, Using Gordon 11 function health patterns assessment tool in the assessment, data was collected through observations, listening, interviews, physical assessment and nursing practice during the nursing period from May 31th to June 5th, 2018. After organization and analysis, we established health problems as followings anxiety, excess fluid volume and potential risk for infection. Using active care, listening, and companionship to establish a good interactive relationship, provide individual nursing, patiently explain disease symptoms, complications, and follow-up treatment, reduce patient’s anxiety, enhance of the Patient’s understanding on the treatment, improve symptoms of dyspnea, maintain balance of intake and output, and diet education. Intensify invasive catheter care in the acute phase, strengthen wound care avoid wound infection. Strengthen the support system and positive thinking through the intervention of medical team and family resources help them to get through the difficulties before the period of liver transplant preparation. It is recommended that units increase pre-operative plasma exchange related information health education manuals and specialized education in the future. Combining the team's ability to communicate and care, through case discussions to strengthen nursing colleagues assessment and intervene timing judgment processing capabilities to help caregivers become more understand their skills in such case care in the future.