照護一位肝臟移植手術後病患之護理經驗

Nursing Experience of Caring for a Liver Transplant Recipient

本文為探討一位肝硬化行肝臟移植（liver transplantation）手術後病患之護理經驗。照護期間為2014年10月11日至10月17日，經由實際護理、會談、觀察、病歷查閱及身體評估等技巧收集資料，以Gorden十一項健康功能型態做整體性評估，確立病患主要有潛在危險性感染、呼吸道清除功能失效、焦慮及知識缺失等護理問題。護理過程中透過主動關懷，建立信賴的治療性人際關係，在潛在危險性感染方面，運用合宜的評估，提供相關照護，如：入住正壓隔離病房、採保護性隔離、限制訪客、觀察傷口及導管有無感染情形、術後給予消毒餐食等，協助病患順利脫離各項管路；於呼吸道清除功能失效方面，應用拍痰叩擊及教導深呼吸咳嗽等護理措施，協助病患度過拔管後呼吸型態改變的過程；在焦慮方面，病患面對重大手術後及對疾病產生不確定感，運用同理心給予陪伴支持，衛教放鬆技巧，安排主治醫師增加病情解釋次數以降低其焦慮狀態；在知識缺失方面，因病患獨自居住，無主要照顧者，擔心出院後自我照護能力不足，主動提供有關肝臟移植手術後相關知識及自我照顧的技巧，增加病患自我照護能力，促使其成功重返社會。希望藉由此護理經驗之分享，能提供日後護理人員臨床照護之參考。 This article examined the nursing experience of a liver cirrhosis patient after liver transplantation. The care period was from October 11 to October 17, 2014. Data was collected using procedures such as actual care, interviews, observation, reviewing medical records, and physical assessment. Gordon's 11 healthy functional patterns were used as a holistic assessment to identify patients with potentially dangerous infections, respiratory failure, anxiety, knowledge deficits, and other nursing problems. Proactive care during the nursing process, establishment of trust in therapeutic interpersonal relationships in case of potentially dangerous infections, use of appropriate assessment, providing relevant care (such as: admission to positive pressure isolation ward, implementing protective quarantine, restricting visitors, observation of wounds and catheters for infection, postoperative disinfection of food, etc.), can assist patients to be free from various tubings. With regards to respiratory failure, the application of phlegm percussion and teaching deep breathing and coughing exercise and other nursing measures can help patients through the changes in their respiration type after extubation. With regards to anxiety, patients often experience great uncertainty when faced with major surgeries and diseases and the use of empathy for support, health education on relaxation techniques, and having more explanatory sessions by the attending physician regarding the disease can help reduce anxiety. With regards to knowledge deficit, as patients often stay alone without major caregivers, they worry about their post-discharge self-care ability. Proactively providing relevant knowledge and self-care techniques after liver transplantation and increasing patient self-care can lead to their successful reintegration into society. It is expected that sharing of nursing experience will provide a reference for future care by nurses.

This article examined the nursing experience of a liver cirrhosis patient after liver transplantation. The care period was from October 11 to October 17, 2014. Data was collected using procedures such as actual care, interviews, observation, reviewing medical records, and physical assessment. Gordon's 11 healthy functional patterns were used as a holistic assessment to identify patients with potentially dangerous infections, respiratory failure, anxiety, knowledge deficits, and other nursing problems. Proactive care during the nursing process, establishment of trust in therapeutic interpersonal relationships in case of potentially dangerous infections, use of appropriate assessment, providing relevant care (such as: admission to positive pressure isolation ward, implementing protective quarantine, restricting visitors, observation of wounds and catheters for infection, postoperative disinfection of food, etc.), can assist patients to be free from various tubings. With regards to respiratory failure, the application of phlegm percussion and teaching deep breathing and coughing exercise and other nursing measures can help patients through the changes in their respiration type after extubation. With regards to anxiety, patients often experience great uncertainty when faced with major surgeries and diseases and the use of empathy for support, health education on relaxation techniques, and having more explanatory sessions by the attending physician regarding the disease can help reduce anxiety. With regards to knowledge deficit, as patients often stay alone without major caregivers, they worry about their post-discharge self-care ability. Proactively providing relevant knowledge and self-care techniques after liver transplantation and increasing patient self-care can lead to their successful reintegration into society. It is expected that sharing of nursing experience will provide a reference for future care by nurses.