照護一位肺臟移植術後病人之護理經驗

The Nursing Experience of Postoperative Care for a Lung Transplant Patient

10.6386/CGN.202003_31(1).0012

陳慧玲(Hui-Ling Chen)；黃惠鈺(Hui-Yu Huang)；莊月娥(Yueh-O Chuang)

肺臟移植 ； 急性疼痛 ； 無力感 ； lung transplantation ； acute pain ； feeling of helpless

長庚護理

31卷1期（2020 / 03 / 01）

134 - 143

繁體中文

本文描述一位62歲男性因面臨肺纖維化需接受肺臟移植手術之護理經驗。筆者自2017年10月24日至2017年12月8日照護過程中，運用Gordon's十一項健康功能型態做整體性評估功能性健康型態收集資料，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，分析歸納個案主要的問題有：疼痛、活動無耐力、潛在危險性感染及無力感等健康問題。針對個案健康問題給予個別性之照護計畫，藉由同理心、心理支持和放鬆技巧，協助個案表達其情緒感受，術後提供合宜的緩解疼痛照護計劃，教導非藥物疼痛緩解方式，降低疼痛不適；介入個別性的復健照護計畫促進個案術後能恢復日常的活動機能，並透過院方舉辦肺臟移植病友分享會，安排成功肺臟移植病友與個案認識，分享治療過程及心情，建立正向心理支持，提升信心。肺臟移植個案在臨床照護上較為複雜，護理人員除減輕術後身體不適外，建議術前及早介入給予心理支持，了解心理層面之需求，冀望藉此護理經驗分享，提供床醫護人員照顧此類病人時，能協助個案以正向、健康的態度，面對未來的生活。

This article described a nursing experience of postoperative care for a lung transplant patient. This 62-year-old man received lung transplantation due to advanced pulmonary fibrosis. The challenge of postoperative nursing care was to help the patient rapidly recover from the physiological, psychological and other unexpected disturbances resulting from transplantation. During the period of postoperative care from October 24 to December 8, 2017, the author used Gordon's 11 Functional Health Patterns Assessment tool to evaluate the health problems. The essential information was collected from actual nursing care, daily physical assessment, patient/family interviews, and chart reviews. The major nursing problems included wound pain, weakness, lacking activity endurance, risks of advanced infections, and a feeling of helpless. The author developed an individualized care plan to help solve the major nursing problems, including skillful emotional supports, non-pharmacological methods of pain relief, and an individualized rehabilitation program. The care plan also included holding several forums in the hospital, inviting lung transplant patients to share their experiences in the physical and psychological recovery from lung transplantation. The author observed that this experience-sharing forum among lung transplant patients could provide some emotional supports to these patients. The postoperative care in lung transplantation is in fact complicated. The medical team needs to solve immediate problems in a timely manner and introduce a rapid recovery plan, both physical and psychological. We presented a fairly comprehensive nursing plan for caring lung transplant patients. The plan also helps our colleagues to be more confident in caring critical patients postoperatively.

1. 郭瑞萍, J. P.,翁靜美, C. M.,陳金玫, C. M.(2015)。護理人員在術後疼痛照護中的挑戰。領導護理，16(4)，11-20。
   連結：
2. 黃棋政, C. C.,謝瓊慧, C. H.(2017)。中西醫結合治療特發性肺纖維化病例報告。中醫內科醫學雜誌，15(1)，46-57。
   連結：
3. Anand, K. J. S.,Craig, K. D.(1996).New perspective on definition of pain.Pain,67(1),3-6.
4. Brown, M.(2010).Nursing care of patients undergoing allogenetic stem cell transplantation.Nursing Standard,25(11),47-56.
5. Christie, J. D.,Edwards, L. B.,Kucheryavaya, A.Y.,Benden, C.,Dipchand, A. I.,Dobbels, F.,Hertz, M. I.(2012).The registry of the international society for heart and lung transplantation: 29th adult lung and heart-lung transplant report–2012.The Journal of Heart and Lung Transplant,31(10),1073-1086.
6. Cooney, M. F.(2016).Postoperative pain management: Clinical practice guidelines.Journal of Perianesthesia Nursing,31(5),445-451.
7. Costa, J.,Benvenuto, L. J.,Sonett, J. R.(2017).Long-term outcomes and management of lung transplant recipients.Best Practice & Research Clinical Anaesthesiology,31,285-297.
8. Gelzinis, T. A.(2018).An update on postoperative analgesia following lung transplantation.Journal of Cardiothoracic and Vascular Anesthesia,32,2662-2664.
9. Hoogervorst, S. J.,Van Boekel, R. L.,De Blok, C.,Steegers, M. A.,Spreeuwenberg, P.,Wagner, C.(2016).Postoperative pain assessment in hospitalised patients: National survey and secondary data analysis.International Journal of Nursing Studies,63,124-131.
10. Hu, L. Y.,Ku, F. C.,Wang, Y. P.,Shen, C. C.,Hu, Y. W.,Yeh, C. M.,Liu, C. J.(2015).Anxiety and depressive disorders among patients with esophageal cancer in Taiwan: a nationwide population-based study.Support Care Cancer,23(3),733-740.
11. Nosotti, M.,Tarsia, P.,Morlacchi, L. C(2018).Infections after lung transplantation.Journal of Thoracic Disease,10(6),3849-3868.
12. Yeung, J. C,Keshavjee, S.(2014).Overview of clinical lung transplantation.Cold Spring Harb Perspectives in Medicine,4(1),1-15.
13. 林思吟, S. Y.,蔡碧雀, P. C(2013)。運用羅氏適應模式照顧一位心臟移植後無力感病人的護理經驗。志為護理，12(6)，98-107。
14. 靳燕芬, Y. F(2007)。傷口換藥疼痛護理。護理雜誌，54(3)，87-91。
15. 衛生福利部中央健康保險署(2017)‧器官移植存活率統計‧取自http://www.nhi.gov.tw/Resource/webdata/30725_2_器官植存活率20160614.pdf.[Central Health Insurance Agency, Ministry of Health and Welfare(2017, Nov 1). Organ transplantation survival statistics. Retrieved from http://www.nhi.gov.tw/Resource/webdata/30725_2 _]