一位接受活體肝臟移植術後病人之照護經驗

Nursing Experience of a Patient with Living Donor Liver Transplantation

本篇描述一位59歲男性因酒精性肝硬化而接受活體肝臟移植的照護經驗，照護期間為2019年11月11日至20日，運用Gordon十一項功能性健康評估架構，藉由觀察、會談及身體評估技巧蒐集個案身、心及社會的主、客觀資料，確立主要健康問題：術後急性疼痛、體液容積過量及焦慮。透過與個案、醫師及營養師等跨團隊合作，擬定個別性之照護計畫，藉由飲食衛教、密切監測電解質及輸入輸出量變化等護理措施，改善體液容積過量情形；透過非藥物的疼痛緩解技巧與醫囑使用止痛藥物的輔助，緩解術後急性疼痛；鼓勵親友陪伴、協助肢體按摩，及提供宗教支持，且每次於執行照護活動前，向個案說明目的及過程，有效的緩解焦慮情緒，最終使其順利轉至普通病房，逐漸恢復健康。希望透過本篇照護經驗之分享，能提供日後臨床護理人員照顧此類個案之參考。

In this case report, we presented a 59-year-old patient who underwent living donor liver transplantation due to alcoholic liver cirrhosis in critical care unit. The period of nursing care was from November 11, 2019 to November 20, 2019. To further investigate the postoperative issues of the patient, theGordon's Functional Health Patterns was applied for assessment, which collected thephysical and mental health datas of the patient from the aspect of both subjective and objective through the process of observations, interviews, and physical examinations. There were three main health issues were identified: postoperative pain, fluid overload after liver transplant surgery and anxiety. After the issues were identified, the individualized care plans were constructed multidisciplinarily by the main caring nurses, nutritionists, and physicians. In order to improve the overloading status of fluid, several nursing interventions were conducted, including the monitoring of electrolytes and fluid status, and education of appropriate diet ingestion. As to the acute postoperative wound pain, both medication and non-medication approaches were applied. For the anxious and disturbed mood, multiple nursing interventions were conducted, including encouragement of family member accompany, assistance of extremities massages, and explicating the purpose and process to the patient before nursing intervention. Through above mentioned nursing plans, the patient was successfully transferred to ordinary ward. In our presented article, we aimed to share the nursing care experience of a liver transplant patient from establishment of nursing plans to implementation of nursing interventions.