照顧一位巨大肝血管瘤病患行體外自體肝臟移植手術全期護理經驗

A Perioperative Nursing Experience of Autologous Liver Transplantation for a Patient with Huge Hepatic Hemangioma

本文探討一位巨大肝血管瘤病患行「體外自體肝臟移植」手術全期護理經驗，筆者為肝臟移植小組之手術全期護理師，由於體外自體肝臟移植手術的困難度相當高，尤其在手術全期護理不常見，引發想深入探討此類手術病患之動機。筆者於2017年7月11日至7月24日住院期間，以Gordon十一項功能性健康型態為評估工具，經觀察、手術前後訪視、病歷閱讀等方式收集資料，確立病患有焦慮、潛在危險性手術情境的傷害、高危險性體溫過低及疼痛。在手術全期護理過程中，筆者藉由手術前訪視，發現病患對於自己即將面臨此次高風險手術感到極度焦慮及不安，提供手術前準備相關訊息，運用傾聽及同理心鼓勵病患表達心中感受。手術中期依照標準作業流程維護病患手術安全，避免潛在危險性傷害發生，給予適當的保暖措施避免病患於手術中低體溫。手術後教導個案減輕傷口疼痛方式及傷口照護衛教等。筆者希望能藉由此次護理經驗，了解病患的需求，提早給予病患合適的衛教與準備，以減少手術前焦慮及手術後合併症情形，進而達到手術全期護理之目的。 This article is an attempt to discuss aperioperative nursing experience of autologousliver transplantation for a patient withhuge hepatic hemangioma. The author is aperioperative nurse from a liver transplantationteam. Since autologous liver transplantation isrelatively uncommon and the high degree ofdifficulty, it motivates the author to conductthis study. During the period from July 11th 2017 to July 24th 2017, data and informationwere collected through observation, priorand after operation visits, and chart review.After applied Gordon's 11 Functional HealthPatterns Assessment, the possibility of patientanxiety, potentially hazardous surgicalsituations, risk of hypothermia and painwere identified. Upon preoperative visit, theauthor found that the patient was extremelyanxious about his upcoming high-risksurgery. The author managed the situation byproviding information related to preoperativepreparation and encouraging the patient toexpress his feeling and showing sympathy tohim. During the surgery, the surgical safetywas maintained through standard operatingprocedures in order to avoid potential injuries.Adequate temperature control was provided, preventing the patient from hypothermia. Theauthor educated the case about wound careand appropriate methods to reduce pain inpostoperative period. Through this experience, the author understands in order to achievea quality perioperative nursing care, it isimperative to recognize the need of patient.Moreover, giving related education andpreparation to patient in an earlier time canassist on reducing preoperative anxiety andpostoperative complications.