理經驗前言 顧一位青少女肝臟移植術後病人的護理經驗TZU CHI NURSING JOURNAL Volume 12. Number 5. October 2013 第十二卷第五期照中文摘要 理經驗 2009 (2010) 江懿真紀孟鳳 * 201005010511Gordon (2013; 12:5, 94-104) 關鍵詞 : 青少年期 肝臟移植手術 膽道閉鎖 高雄長庚醫院外科加護護理師高雄長庚醫院肝臟加護病房護理長 * 接受刊載 :2012 年 7 月 30 日通訊作者地址 : 紀孟鳳 833 高雄縣鳥松鄉大埤路 123 號電話 :886-7-731-7123 轉 8541 電子信箱 :cpho@adm.cgmh.org.tw ( 2007)50 (2009) 文獻查證 (biliary atresia) (2007) (2007) (2007) (2007) prednisolone cyclosporinetacrolimus(2007) (Faenza et al., 2005) (2007) ( 2008) (Brolese et al., 2007) (2010) 94 95
顧一位青少女肝臟移植術後病人的護理經驗TZU CHI NURSING JOURNAL Volume 12. Number 5. October 2013 第十二卷第五期照 理經驗 3.0g/dl, BUN: 56 mg/dl, Cr: 1.42 mg/ dl3+5/550.3 4/27 5/650.8 160 50BMI18.9() V/B ( 三 ) 排泄功能 (2008) 86 78 4/29 52 45 ( 二 ) 營養與代謝 1,250~2,000ml/ 19 17 ( 四 ) 活動與運動 (2009) 圖一家庭圖譜 5/21,090 450ml450 Woodgate(2005) 二 疾病過程 cyclosporine() triflowippb 160 465/550.3 20098 535/5 5 ( 五 ) 睡眠與休息 (Woodgate, 2006) 201022 5/6 6~9 11 19 1500/ 2010427 5/5 (Woodgate, 5/6 2005) 三 整體性護理評估 20100501 20100511 ( 六 ) 認知與感受 (2009) Gordon? 一 個案簡介 護理過程 ( 一 ) 健康認知及健康處理 0.5 5/3~5/8I/O 5/3 (+1500)5/5 (+1732) 770ml2,190ml Na: 126Meq/L, K: 5.2Meq/L, Albumin: 96 97
顧一位青少女肝臟移植術後病人的護理經驗TZU CHI NURSING JOURNAL Volume 12. Number 5. October 2013 第十二卷第五期照3 理經驗 5/5 (3,830ml/) 5/10 ( 十 ) 因應與壓力感受 5/6 ( 一 ) 營養狀況改變: 少於身體需要 / 胃口差 怕胖導致 5/8 ( 七 ) 自我感受與自我認知 16050 50 5/650.8 ( 八 ) 角色與關係 ( 九 ) 性與生殖 5/5 5/6 5/6 5/8 ( 十一 ) 價值與信念 確立問題與護理診斷 201005010511 Gordon S 5/5 5/6 5/6 5/6? O 5/2450 1,090 450ML 5/3 alb3.0g/dl 2+ 5/5 5/550.3 BMI20 1.5 10 2. 510 1,500~2,000 1 1. (1) 5/5~5/10 (2) 5/5~5/10 (3)5/6 ( ) (4) 5/5~5/10 (5)5/6 (6)5/71,500/ 2.5/8 3. 5/6-5/9 HTPN1,500/ 6/TPN 1.5/6 2. 5/101,925/ 5/3 3. 5/10 4. 5/9alb3.5g/dl 1+ 98 99
顧一位青少女肝臟移植術後病人的護理經驗TZU CHI NURSING JOURNAL Volume 12. Number 5. October 2013 第十二卷第五期照( 二 ) 知識缺失/ 不瞭解術後復原過程及術後自我照顧注意事項導致理經驗( 三 ) 個人因應能力失調 / 對術後復原緩慢導致 S 1.5/5 2.5/5 3.5/5 4.5/6 5.5/8 O: 1.5/5 (3,830ml/) 2.5/5 3.5/8 1.58 2.58 3.5 10 1. (1)5/5 (2)5/6 2. (1)5/5 (2)5/5 ( ) ( ) (3)5/5 3. 5/7-5/11 20-30 (1) (2) (3) 38 (4) 4. 5/7-11 5. 1.5/8 2.5/8 3. 5/10 4.5/7 38 5. 5/10 90 5/11100 S 1.5/5 2.5/6 3.5/6 4.5/7 5.5 / 8 O 1. 2. 3. 4. 5. 1.510 2.510 1. (1) 5/1~5/10 (2) 5/1~5/10 (3) 5/5~5/8 (4)5/7 (5) 5/5~5/10 2. (1)5/5 (2) 5/6~5/10 (3)5/7 (4)5/7 1. 5/10 2. 5/10 3. 5/10 4. 5/10 100 101
顧一位青少女肝臟移植術後病人的護理經驗TZU CHI NURSING JOURNAL Volume 12. Number 5. October 2013 第十二卷第五期照理經驗結論與討論 參考資料 行政院衛生署 (2009,10 月 1 日 ) 台灣地區主要死因歷年統計結果 2010 年 6 月 14 日取自 http://www.doh.gov.tw/statistic/data/ 衛生統計重要指標 /8.xls 吳麗敏 金繼春 (2009) 一位白血病青少女復發後的生病經驗 榮總護理,26(1), liver transplantation: The University of Padua experience. Transplantation Proceedings, 39, 1939-1941. Faenza, S., Bernardi, E., Cuppini, F., Gatta, A., Lauro,A., & Mancini, E. et al. (2005). Intensive care complications in liver and multivisceral transplantation. Transplantation Proceedings, 37(6), 2618-2621. Woodgate, R. L. (2005). A different way of being: Adolescents experience with cancer. Cancer Nursing, 28(1), 8-15. Woodgate, R. L. (2006). Life is never the same: Children cancer narratives. European Journal of Cancer Care, 15(1), 8-18. 1-8 (2007) 胡瑞恆 (2007). 肝臟移植. 台灣醫學,11(1),56-61 翁慧玲 楊素卿 李伯皇 賴鴻緒 何明志 張美惠 (2007) 膽道閉鎖兒肝移植前後之生長及骨密度狀況 台灣醫學, 11(1),8-14 莊嫻儒 葉芳枝 (2008) 照顧一位接受腎臟移植患者之護理經驗 中山醫學雜誌, 19(1),113-126 黃紀諺 沈瑞玲 林玉如 (2007). 肝臟移植前後之重症護理. 榮總護理,24(3), 313-319 潘雪幸 張慕民 蕭存芳 張秉宜 吳品萱 (2008). 加護病房病人之壓力源及其護理. 長庚護理,19(3),353-359 劉淑倩 黃芷誼 李秋琴 胡雅娟 (2010). 即使已達智慧圓融, 更應含蓄謙虛, 像稻穗一樣, 米粒愈飽滿垂得愈低 ~ 證嚴法師靜思語 ~ Those who have great wisdom must all the more be humble and unassuming, just like the rice stalk that bows under the weight of ripe grain. ~ Master Cheng Yen ~ 肝臟移植手術後護理指導之改善專案. 長庚護理,21(3),323-334 謝靜惠 賀國珍 (2007) 一位先天性膽道閉鎖患孩母親之壓力及因應行為 長庚護理,18(1),112-119 羅俞冠 陳淑賢 邱姵綺 (2009) 一位肝移植合併肝硬化青少年的護理經驗 長庚護理,20(3),375-383 Brolese, A., Vitale, A., Zanus, G., Boccagni, P., Neri, D., & Gringeri, E. et al. (2007). Pediatric 102 103
理經驗A Nursing Experience of an Adolescent After Liver Transplantation Yi-Chen Chiang, Menc-Fenc Chi* ABSTRACT This report described a nursing experience of a biliary atresia female adolescent who had to receive liver transplant due to liver cirrhosis. The nursing period lasted from May 1 st to May 11 th, 2010, the author applied Gordon s 11-item functional health pattern assessment to evaluate the patient s health condition and gathered information through direct care, observation, conversation, physical assessment and accessing medical record. Several health issues were confirmed, such as altered nutrition: less than body requirements, knowledge deficit and ineffective individual coping. During post-operative period, the author informed the patient on reasons leading to ascites and instructed correct diet intake to improve the patient s appetite and resolve malnutrition due to concerns for weight gain. Furthermore, the author applied a brochure individualized medication log for postliver transplant patient and Self care instruction for post-liver transplant, medication recognition cards and DVDs to increasing the patient s self-care ability. By sharing these experiences, we hope to improve the nursing experience and quality of care for patients receiving liver transplantat. (Tzu Chi Nursing Journal, 2013; 12:5, 94-104) Keywords: adolescence, biliary atresia, liver transplant RN, Kaohsiung Chang Gung Memorial Hospital; Head Nurse, Kaohsiung Chang Gung Memorial Hospital* Accepted: July 30, 2012 Address correspondence to: Menc-Fenc Chi No.123,Ta-pei Rd.,NiaoSung Township, Kaohsiung County 83301, Taiwan Tel: 886-7-7317123 ext.8541; E-mail: cpho@adm.cgmh.org.tw 104 TZU CHI NURSING JOURNAL