一位酒精性肝硬化病人肝臟移植術後急性混亂之護理經驗

A Nursing Experience of an Alcoholic Liver Cirrhosis Patient Suffering from Acute Confusion After Liver Transplant

吳晨綠(Chen-Lu Wu)；王湞雅(Chen-Ya Wang)；蔡佩臻(Pei-Chen Tsai)

肝臟移植 ； 羅氏適應模式 ； 急性混亂 ； acute confusion ； liver transplant ； Roy's adaptation model

志為護理-慈濟護理雜誌

18卷2期（2019 / 04 / 01）

118 - 128

繁體中文

本文描述一位54歲個案因酒精性肝硬化接受肝臟移植手術的照護經驗。筆者於照護期間2017年5月10日至6月1日運用羅氏適應模式評估，確立個案主要健康問題有：急性混亂、體液容積過量、焦慮。在護理過程中，彈性增加會客時間以提供個案安全感、調整病室內燈光以增加定向感、與醫師討論增加輔助藥物促進夜間睡眠等策略，順利度過手術後的急性混亂階段。與營養師、醫師共同討論調節個案水份攝入與排出，並給予合適的飲食衛教，改善個案體液容積過量狀態。再則，協助個案了解移植術後的病程進展、耐心回答個案反覆性疑問及指導放鬆技巧，成功降低焦慮程度，最終使個案順利轉至普通病房，並逐漸恢復健康。

This article described a nursing experience of a 54-year-old patient with alcoholic liver cirrhosis undergoing liver transplant. From May 10^(th) to June 1^(st), 2017, the authors conducted a comprehensive evaluation of the patient by applying attentive listening, written communication and Roy's adaptation model, confirming major health problems including acute confusion, fluid volume excess and anxiety. To address the patient's post-operational acute confusion, the nursing interventions we provided during the nursing process included flexible meeting time to bring the patient a sense of security, adjustment to the ward lighting to regain usual reality orientation, and discussions with the physician on administering complementary medicine to improve night-time sleep. For the fluid volume excess, we planned with physicians and dietitians on nursing interventions including monitoring the balance of the patient's fluid intake and output, and educating the patient and the family the importance of proper nutrition and diet modification. Furthermore, to reduce the patient's level of anxiety, we educated the patient and the family about the course of post-transplantation, patiently answered the patient's repeatedly doubts and instructed the patient with relaxation techniques. Ultimately, the patient was successfully transferred to the general ward and continues to recover gradually.

1. 李美娟(2015)。一位初次血液透析病人遭逢喪夫之痛的護理經驗。台灣腎臟護理學會雜誌，14(3)，61-75。
   連結：
2. 潘容芬,陳春香,湯婉孄(2016)。一位主動脈剝離術後病人之重症護理經驗。志為護理，15(3)，82-91。
   連結：
3. Bates, C.(2017).Confusion and delirium in the acute setting.Medicine,45(2),110-114.
4. Fan, Y.,Guo, Y.,Li, Q.,Zhu, X.(2012).A Review: Nursing of Intensive care unit delirium.Journal of Neuroscience Nursing,44(6),307-316.
5. Mark, F.(Ed.),Friedman, L.S.(Ed.),Brandt, L. J.(Ed.)(2016).Sleisenger and Fordtran’s Gastrointestinal and Liver Disease.Pennsylvania, PA:Saunders.
6. Verklan, M. T.(Ed.),Walden, M.(Ed.)(2015).Core Curriculum for Neonatal Intensive Care Nursing.St. Louis, MO:Mosby.
7. 王思涵,謝佳恩,王俊毅,林惠娟,林麗絲,陳堯俐(2012)。酒精性肝硬化患者行活體肝臟移植術後加護病房瞻妄之危險因子分析。重症醫學雜誌，13(4)，178-184。
8. 行政院衛生福利部(2017，7月16日)．民國105年死因統計結果分析 ．取自http://dep.mohw.gov.tw/DOS/lp-3352-113.html
9. 行政院衛生福利部 (2017，7 月 16 日)．器官移植作業準則．取自 www.ttpc.mohw.gov.tw/public/gpi/d9ce549ea79ea7ec161697d2fca2da0a.doc
10. 陳依鈴,孫守涓,黃采薇(2012)。外科加護病房病人譫妄發生率及相關因素探討。彰化護理，19(4)，33-40。
11. 陳盈蓉,陳雅玲,許莉宛(2016)。一位初次診斷肝癌術後病人之照護經驗。高雄護理雜誌，33(2)，49-59。
12. 楊惠茹,葉淑蕙,邱鈴惠(2013)。一位肝臟移植病人術後之加護護理經驗。秀傳醫學雜誌，12(3,4)，109-116。
13. 褚淑芸,徐淑芬(2015)。一位肝硬化併發腹水及肝性胸水病人之加護護理經驗。馬偕護理，9(1)，42-53。
14. 劉淑倩,黃芷誼,李秋琴,胡雅娟(2010)。肝臟移植手術後護理指導之改善。長庚護理，21(3)，323-334。

1. 龔盈帆,鍾幸枝,黃聖惠(2022)。照護一位酒精性肝硬化行肝臟移植術後病人之加護經驗。榮總護理，39(1)，81-88。
2. (2023)。照護一位酒精性肝硬化病人之護理經驗。中科大學報，10(1)，43-57。