末期酒精性肝硬化病人之照護經驗

Nursing Care of a Patient with End-Stage Alcoholic Cirrhosis

10.6142/VGHN.201806_35(2).0010

蘇盈如(Ying-Ju Su)；連靜雯(Ching-Wen Lien)；溫明寰(Ming-Huan Wen)

酒精性肝硬化 ； 末期肝病 ； 腹水照護 ； alcoholic cirrhosis ； end-stage liver disease ； nursing care of ascites

榮總護理

35卷2期（2018 / 06 / 01）

205 - 212

繁體中文

本文描述一位49歲男性因長期飲酒導致酒精性肝硬化末期，因嚴重腹水、肝腎症候群等合併症，且面對只能等待屍肝機會的無望感之照護過程。照護期間為2017年8月15日至9月15日，筆者透過觀察、會談等技巧，收集病人身、心、靈各方面資料，以Gordon十一項健康功能型態工具評估確立健康問題，包括體液容積過量、身體心像紊亂、無望感等，並透過與病人建立良好護病關係，共同討論並擬定照護計畫、設定目標。期間提供腹腔放液、低塩、限水飲食計畫及改變烹調方式，密切監測體重變化等措施，改善身體不適；運用鼓勵表達自身感受，協助了解罹病事實，鼓勵家庭支持等，讓病人重拾信心，肯定自我價值；積極正向面對疾病延長壽命，以等待肝臟移植機會；筆者建議能編制慢性肝病個案管理師，對肝病病人照護能更加完整。

This paper describes the nursing care of a 49-year-old man with alcohol-induced cirrhosis. The patient was in the end stages of alcoholic cirrhosis with serious complications such as ascites and hepatorenal syndrome. The patient faced the psychological impact of waiting for a liver transplant as well as feelings of hopelessness. The period of care described herein was from August 15, 2017 to September 15, 2017. The authors collected information about the patients' physical, mental, and spiritual health through observation, interviews and other techniques. Assessed using Gordon's 11- item functional health assessment, the patient's health problems included excess fluid, disturbed body image, and hopelessness. During the care process, a relationship was established with the patient to discuss and mutually develop a care plan. The developed plan focused on problems of excess fluid management, and included nursing interventions for abdominal paracentesis, a low-salt diet, fluid restrictions, changes to cooking habits, and weight monitoring. To address the patient's disturbed body image and hopelessness, he was encouraged to express his feelings, to use his fellow patients for support, and to understand the facts of his illness with encouragement from his family. Using the developed care plan, the patient could try to regain his confidence by affirming his self-worth. Furthermore, the care plan provided the patient with a chance to extend his life expectancy while waiting for a liver transplant. Employing this form of care management for patients with chronic liver disease could help provide more complete nursing care.

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