一位肝癌合併出血性休克病人之護理經驗

A Nursing Experience of a Patient with Hepatic Carcinoma

10.3966/102673012017122804011

林德華(De-Hua Lin)；張湘媚(Shiang-Mei Chang)

肝癌 ； 食道靜脈瘤 ； 出血性休克 ； hepatic carcinoma ； esophageal varices ； hemorrhagic shock

長庚護理

28卷4期（2017 / 12 / 01）

698 - 708

繁體中文

本文敘述一位61歲肝癌病人，因急性食道靜脈瘤嚴重出血引發出血性休克之照護經驗。照護期間2015年4月12日至2015年4月20日，藉由身體評估、觀察、會談及查閱病歷等技巧收集資料，進行生理、心理、社會及靈性之整體性評估，確立病人有體液容積缺失、急性疼痛及焦慮的健康問題。於照護過程中，依循護理評估持續監測及觀察食道靜脈瘤出血之徵象，早期發現出血危象，即刻介入醫療處置控制出血，依據病人疼痛分數擬定疼痛控制目標，運用藥物與非藥物之方法減輕疼痛，促進病人舒適，同時和病人建立信任的護病關係，使病人瞭解疾病進展並參與討論，藉由調整會客時間，讓家屬陪伴，並尊重其宗教信仰，增進心靈舒適以減緩焦慮不安的感受。透過此次分享期望能提供醫療團隊照護上之參考。

This article described a nursing experience of a 61-year-old patient with hepatic carcinoma who suffered from hemorrhagic shock by severe bleeding of acute esophageal varices. The author used the holistic nursing assessment of physical, psychological, social and spiritual dimensions via physical assessment, observation, interview, and review of medical records from April 12th to April 20th 2015. The health problems we identified included fluid volume deficit, acute pain, and anxiety. We kept monitoring and observing bleeding signs of esophageal varices, and administered it immediately. In addition, we developed specific pain control objective based on the pain score of the patient observed in the nursing care process. We used pharmaceutical and non-pharmaceutical therapies to ease pain to the patient. At the same time, we established a mutual trust nurse-patient therapeutic relationship with the patient, making him understand the progress of the illness and discuss medical objective with his healthcare providers. The family members were allowed to stay and accompany the patient by means of adjusting visiting time appropriately. We respected the patient's religion to promote his psychological and spiritual wellbeing and relieve his anxiety toward the end of life. We shared this nursing experience as a reference for nursing care of terminal-illed patients.

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