!"#$%&'()*+,--./0. The Nursing Experience in a Post-cholecystectomy Elderly Patient at ICU G G

Transcription

1 VS!"#$%&'()*+,--./0 The Nursing Experience in a Post-cholecystectomy Elderly Patient at ICU G G!"#$%&'()*+,-./0123)4'56*789:;*<=>?@A'BCD!"#$%&'()*+,-./$ )89:;"<1=>?@ABCDEFGH UU!"#$%&'()*+%,-./012# :;#<=>?@!AB@CDE# dçêççå=!"#$%&'()*+,-.!"/012nk!"#$%&'ok!"#$% PK!"#$QK!"#$RK!"#$%&'()*+,-./0&123"-456#789:!"#$%&'()*+,-./01234%156789:;%1<=)>?&@ABCD%&EF!"#$%&'()*+,-."/ :;<=>3?@ABCD-EF(GHB!"#$%&'()*+E!"#I=2003; 2:3, F!"#$%&'()*!"#$%&'()*+,-./012!"#$%&'()*+,-./&0123!"#$%&'()*+,-./01'(2!"#$%&'()*&+#,-./012!"#$%&'()* +,-./012!"#$%&'()*+,-.#/01%2 UU!"#$%&'()*+,-$./!"#$%&!'()*+,-."/012!"#$%&'()* +,-./#012!"!!"#$!"#$%&'=! G!"VN T OU ==!"VN NM OQ ==!"VN NO OP!"#$%&' NNO!"#$% OMN!"#$%&'(' f`r EMOFOUTRTMON!"#$ O P! VO V

2 !"#$%&'() VT!"#$%&' ()*+,-./!"#$%&'()*+,-./ 012!"#$%&'EOMMMF!"#$!"#$%& '()*+,-./01!"#$%&'()*+,-./01234!"#$E NVVPF!"#$%&'!"#$%&'()*+,-.$/01!!"#$%&'!"#$%&'()*"+,-./01!"#$ %&'()*+%,-./0 1!"#$%&'()*+,-$."/01!"#$%#& '(%)*+,-./01!"#$%&'()*+,-./0123!"#E! NVVUF!"# NK!"#$%&'(!)*+,-./0"1!NM!"#Em~lOFQ=ããeÖ UM!"#$%&' TM=ããeÖE! NVVUF!"#$%&'()*+,-./$012!"#$%&'()*+,-./0123!"#$%&'()*+,-./ OK!"#$%&'()*+,-. /01!"#$%&'()*+,"-./012!"#$%&'()*+,-./012 E NVVRF!"#$%&!"#$%&'()*+,$-./01!"#$%&'()*+,-.#/0123!"#$%&'()*+,-./0123!"#$#%&'()*+,-!"#$!"#$%&'()*+,-./0!"#$%&'()*+,-./01234!"#$%&' NK!"#$%&'()*+,*-.,`J!"#$%&'()*+,-./0123 OK!"#$%&'( PK!"#$%&'()*+,"-./012!"#$%&'()*)+,-.&/0!" NLO OLP!"#E NVVQF!"#$%&!"#$%&'()*+,-.%&/0!"#$%&'()*+#,-./0123!"#$%&'()*+,-./01234!"#$ %&'( )*+,-./012!"#$%&'()*+,-./012)3!"#E! OMMMF!" NK!"#$#"%&"'()*+,-./0!"#$%&'(#)*+,-.#/01! OK!"#$%&'()*+,-./0()1!"#$%&'()*+ PK!"#$%&'()*+,-./012!"#$%&'()*+,-./01!E OMMN! NVVRF!"#$ %&'()*+,-./0$.!"#$%"&'() *+,-./'!"#$%&'()*+,-./01234!"#$%&'()*+,-$./Eeáää=C pãáíünvvmf!"#$%#&'#()*+,!"#$%&'()*&+,-./0123!"#$%&'(envvrf!"#$!"# NK!"#$%&'()*+, -./!"#$%&'()*+,-./OK!!"#$%&'()*+,-. /01PK!"#$%&'(QK!"#$%&'(!"#$%RK!"#$%&'()*+!"#$%&SK!"#$%&'()* TK!"#$%&'()*+,-./0)*1!"#$%&'()*+E NVVVF!"#$%&'()! VO V!"#$ O P

3 VU!"#$%&'()*+,-./01!"#$%&'()*+",-./01!"#$%E^èìáäÉê~I=NVVQF!"#!"#$%&'() NK!"#$%&'()*+,-./OK!"#$%&'()*+,-.#/0 PK!"#$%&'()*+!,-./0!"#$%&'()*!+,-./01QK!"#$%&'()*+,-.RK!"!"#$%&'()*+,-./SK!!"#$%&'()*!+,-.ENVVN i~å NVVN! "# NVVVF! UU! NTR=Åã SUKV=âÖ!"#$%"&'()"*+, "-./0!"#$ %&'(d~ää=ää~ççéê=ëíçåé!tlno TLOT!"#$%&TLNP TLOM!"#TLNQ TLOM EF!"#$%&'()*+NM!"P!"#$%&!"#$%&' VM T V!"#$%!"#$%&'NO!"#$%!&!"#$%&'()%*+,-./01 UU= ST= SS= =SQ= =SO= =SN= =RU= =RR= RP= NK!"#$!"%&'"()*+ OK!"#$%&'()*+,-'.!"!"#!"#$%&'()*+,-./ jçêêáëçå==éçìåü! gjm!"!"#$%&'()*+,-./012 T NP!"#$%&'(! UU= dçêççå!"#$%& '()*+,!"!"#$%&!"#$%$&'()*+$&,*+!"#$%&'()*+,"#-NR!"#$%&'()*+,-./01234!"#$%&'()*jçêêáëçå=éçìÅÜ!"#$%&' PM QMãä T NP NS!"#$%&'(!"#$%&'()*+,*-., `om!"#$%&'()*+,-./01234 L!"#$%&'()&*!"#$%&'()*+, TLNP TLNQ TLNR TLNS TLNT TLNU TLNV TLOM EããeÖF NNM NPM NNU NPO NQU NSO NPM NRO NPU NSS NQM NSM NPO NSS NOUúNRO EããeÖF SM UM SM UQ TQ UU TM VM UO VM TU US UM VS TQ UU!EF PTKU PUKP PUKU PTKS PTKM PTKO PSKR PSKO E L F TO VM TS NMS VS NNQ VM NNO US NMU TS VO TO UQ TT UV E L F OP PO NM NQ NO OM NO OO NM OM NM OM NM NU NM NU EÅìããF NOSMM NOTMM NROMM NPSMM NMQMM NMOMM VVMM UOMM EÅìããF NOTMMM NTNMMM NSRMMM OMTMMM ONRMMM OMQMMM OOMMMM OMVMMM `! NOKRS OUKSU NMKUQ NKQQ!"#$ O P! VO V

4 !"#$%&'() VV!"#$! NTR!" SUKV!"#$ SSKR!"#$%&'()*+,-./012 NUMML!"#$%&'()(*+,!"#$%TNS! "#$%&'(!"!# $%&'()*+,-./0!"#$%&'()*+,-./0 L!!!"#$%&'()*+,-./012!"#$%&'()*+,-./0k~NPO NPU hpkp QKP _rks OV `êmkn NKU!"# NUMM OQMM``!"#$%&'!"#$%!"#!"#$%&'()*)+ T NPJNS!"#$%&'()NRMJOMM=ãäL!"#! ORJPO Lãáå ujê~ó!"#$!"#$!"#$%&'()*!"#$%&'()*+,-./012!"#$%&'()*+,-. L!!"#$%&'()!"#$!"#$%&'()*+,-./012!"#$%&'()*+,-./0123+!"#$%&'()*+,-!./0123!"#$%&'()*+, L!"!"#!"#$%&'()*+,-$./01!"#$%&$!"'()*"+,-.!"#$%&'()*+,-./01234!"#$%&!"#$%&'()*+,-./012!" #$#% &'()*+,-. TLNP TLNQ TLNR TLNS TLNT TLNU TLNV TLOM!=E L F SOT NUOM NUOO NTUT NQQR NSUV NTUM NSRQ =EÖãLÇäF OKR OKV PKU QKN EhÖF SUKV TMKQ SVKR!"#$%&'()*+, TLNP TLNS TLNS TLNT TLNU TLNV jççé ^L` mlp slj slj slj kl` cálo QMB ORB QMB QMB OUB QiLã o~äéë o~äéë o~äéë o~äéë `äé~ê `äé~ê ée TKQSU TKPQP TKQNO TKQON TKPSP TKQMP m~lo=eããeöf TSKU UMKU NMSKS NOQKP VSKO VMKT m~`lo=eããeöf OTKQ PMKO POKN OUKV PNKU PMKN e`lp=eããçäläf NVKV NSKR OQKQ OMKM ONKO OOKM p~í=ebf VVKO VRKQ VVKU NMMKM VUKS VUKU ^L`^ëëáëí=Åçåíêçä==mLpmêÉëëìêÉ=ëìééçêí=sLjsÉåíêá=ã~ëâkL`k~ë~ä=`~ååìä~==oL^oççã=~áê! VO V!"#$ O P

5 NMM!"#$%&'()*+,-./0123!"#$%&'(')*+,-./012)!"#$%&'()*+,-./0123#!"#$ %&'()*+,-*./01!"#$%&'()*+,-./0123!"#$%&'()*+,-./01234 L!"#$%&!#'(!"#$!"#$%&'()*+, "-./0!"#$%&'()*+,-./01234!"#$%&'()*+,-./0!123!"#$%&'()*+$!"#!"#$%&'()*+,-./01!"#$% TM!"# O S!"!"#$%&'()*+,-&!"#$%&!"#$%&'()*+,-./012!"#$%&'()*+,-./01"23!"#!"#$!"#$%&'()*+,-./(+0!"#$%&'()*+,'-./0+1!"#!!"#$%&' L!"#$%&'!"#!"#$%&'()*+#$,-./!"#$%$&'()*+,-./ pwnkt NP =!"# NK!"#$%&"#'()*+,- NKT NP NS!"#!"#$%&!"#!"#$%& OKT NQ!"# OK!"# NMMB!"#$%&'!"!"# OKT NQ!" lwnkt NPJNS PK!"#$#%&'()*+ mp=ãççé!"#$!"#$%&' QK!"#$%&'()*$%+,- NM NQ L!"# ujê~ó!"#$%&'( PKT NR!"#$%!"#$%&!' RK!"#$ m~lo TM=ããeÖ!!"#$%&!"#$%&'(! pmlo VRB!"#$%&'( NRMJOMMãä SK!"#$%&! QKT NS!"#"$ OKT NP =cálo=pmb qjéáéåé=cálooub O!"#$!"# QMB!"#!"#$%&'()*)+&', W metkqsu!"#$%& '&()*+,- metkqno m~lotsku=ããeö!"#$%&'( m~lonoqkp=ããeö m~`lootkq=ããeö TK O!"# NR!"#$% m`lopokn=ããeö!"#$ O P! VO V

6 !"#$%&'() NMN e`lpnvkv=ããçälä!"#$%&'()*+,-. e`lpoqkq=ããçälä p^qvvkob!" p^qvvkub!"# OR PO UK!"#$%&'()*+,-. RKT NS!"#$%!"#$!%&!"#$%&'() P!!"#$%&'!"#$! N ujê~ó!"#$% PKT NS!"#"$!"# QMB SKT NV! lo=qil p~ívukub!"#$% L!"#$%&'()&!"#!"#$%&'()*+,! PTKR!"#$ NMMMM=Åìãã!"#$%&'()*+,- pnkt NQ!"#$ NK Q!"#$%&'()*'( NKT NT OM!"#$%&'(!" N!"#$%&'() PSKP PTKO!"!#$%&!UOMMNMQMMLÅìãã lnkt NP NS OK!"#$%&'()*+,-./ PKQ=ÖãLÇä PTKS PUKU!"#$%& OKT NR!"#$%!NOSMM NROMM PK!"#$%&'()(*(+,-!"# LÅìãã!"#$%&'()*+*,-! PKT NV!"#$% OKQ OKU=ÖãLÇä!"#$%&'()*+,-.!"#$%&'(!NOTMMM OMTMMM! LÅìãã QK!"#$%&'()*+,-. QK T OM!"#$%!"EJF!"!"#$%&'() OK!"#$%& NR RK!"#$%&'#()!#*+ RK!"#$%&'(!"#$ J!=NLO OLP!"#$%!"#$%&'( SK!"#$%&'()*+,-./!"#$%&'( PKT NP! "#$!"#$%&'()*+!",- PSJPT!"#! NRMJOMM=ãä!"#$%&'( TK!"#$%&'!"#$%& UK!"#$%&'()*+,-,. QKT NQ!"#$%!"#$%&'()*+!"#$%&'( VK!"#$%&'$()$*+)!"#$%&'( `J!"#$%! VO V!"#$ O P

7 NMO!"#$ L!"#!"#!"#$%&'()*+,-. NUMM!"#$%$&'()*+ QÖLÇä pnkt NQ!"#$!"#$ET NP NS F NKT NR!"#$!"#$ NK!"#$%&'()*+, OQ =UM=ãäLÜê! OKT NS!"#$!"#$%&'()* RB!" Q!"#$%!"!"!"#$%& èn OÜ!"# PM=ãä!"#!"# lnkt NQ!"#$% OK!"#$%&'()*+",-./ OKT NQ NS!" EJF RB!!"#$!=NTUT NUOO PMãäLÜê!" PK!"#$%&'()"*+, PMãäLÜê L!" Q!" N!"#$ PKT NR OM OKT NP =^ääokr=ölçä!"# èo QÜ!"#$%!EF T NU =^ääpku=ölçä QK U!"#$%&'()*+,-. QKT OM =^ääqknölçä!"#$%&'( PKTLNS!"#$% RK!"#$% NUMM!"#$% RK!"#$%&'!"#$%&'!"#$%&'()*+,- T OQ!!"#$ SK O!"#$#%&'( PKM=ÖLÇä ^ääqkr=ölçä!"#$%&'( ORB!"#$% TK Q S!"#$%&'#$()!"#ET NS OM F!"# Q S!"#$%&'() NK!"#$%&'()*+,-./0!"# OK!"#$%&'()*+,*-!"#$ PK!"#$%&'()*+,-./0!"#$% QK!"#$%&'()*+,-./01 RK!"#$%&'"()*+,-./0 SK!"#$%&'()*+ TK!"#$%&'()*+,-./ UK!"#$%&'()*+,-./0!"#$%&'()!#*+,!"#$ O P! VO V

8 !"#$%&'() NMP!"#$=L=!!"#!"#$%& Q S! pnkt NR!"#$ NK!"#$%&'(W! NKT NU!"!"#$%!"#$%&'(!"#$%&'(!=!"#$ OK!"#$%&'()*+,-$./!"#$%&'(!"#! PK!"#$%&'(&)*+,-. QJS!"#$%&!" #$%&'( OKT NV!" QK!"#$%&'()*+,-#$!"#$%&'( lnkt NR!"#$!"#$%&'()*+,-!"#$%&!"#$%&' RK!"#$%&'()*+,-./!" SK!"#$%&'(")*+,-. OK!"#$%&'!"#$!"#$ NJO TK!"#$%&'()*+,-$.!"#$% O!"!"#$% UK!"#$%&'()*+,-#. PK!"#$%&' VK!"#$%&'()*+,-./!"#!"#$%&'( L=!"#$%&!#'!"#!"#$%&'()*+,-./ !"#$%&'()*+,-./%012!"!" NKT NQ!"#$% pt NP!"# NK!"#$%&'()*+,-./!"#$%&'(!"#$%&'() OK!"#$%&'()*+#,-.!"#$%!"#$%&'()!"#$%&'()*+,-$./ OKT NR!"#$% PK!"#$%&'() OQ!"!"#$%&'(!"!"#$%&'(!"#$%&'( pwnkt NP!" QK!"#$%&'()*+,-.!"#$%&'!"!#$%&' RK!"#$%&'()*+,-./ PKT NS!"#"$ \!"#$!"#$%!"#$%&'(!"#$ SK!"#$%&'()*+",-.!"#$%&'( OK!"#$%&'()!"#$% QK!"#$%&'(!"#$\!"!"#$%&'(! VO V!"#$ O P

9 NMQ PKT NQ!"#$ NK!"#$%&'()*+,-./!"#$%&'(!""#$%&'!"#$%&'()*+,-./!"#$%&'( lwnk!"#$%&'(!"#$%&'!"#$%$&' OK!"#$%&'()*+,-./!"#$%&'(!"# PK!"#$%&'()*+&,%- OK!"#$%&'( QK!"#$%&'()*+,-./!"#$%&'(!"#$%&'()*+,-./!"#$%&'( RK!"#$%&'()*+,-.!"#$%&'(!"#$%! SK!"#$%&' ()*+,-.!"#$%&'()*+, TK!"#$%&'()*+,-./!"!"#$%&'()*+,-./0!"#$%&'()*+,-./0123!"#$%&'()*+,-.!/0123!"#$%&'()*+,-./0&'!"#$%&'()*+,-./0123&!"#$%&'()*+!,-./0123!"#$%&'()*+,&-. /012!"#$%&'()*+,-./01234!"#$%&'()*+,-./0123!!"#$%&'()*+,-+./0123!"#$%&'()*+,-./01!!2!"#$!%&'()*+,-./012!"#$%&'() *+,-./01(2!"#$%&'()*+,-./012/3!"#$%&'()*+,-./01234!"#! ENVVRF!"#$%&'()*+,)-.!"#$ QOEOF OMJOT ENVVQF!"#$%&'()* *(!"#$%!"#$EOMMMF!"#$%&'()*!"#$%& OEQF OUUJOVV!"#$!%&'!()*!+,-!./0!!"#$EOMMMF!"#$%&'()*+!"#$ENVVUF!"#$%&'()* ENVVQF!"#$%&'()*+,-. REOF RTJRV EOMMMF!"#$%&'( ONEOF ROJ RP EOMMNF!"#$%&'()*+,-!!"# OEQF OUUJOVV ENVVNF!"#$%&'()*+,-. OENF TSJUM ENVVRF!"#$%&'()*+,-. SEOF URJUV ENVVPF!"#$%&'()*+,- PSENMF OR!"#$!%&'ENVVVF!"!#$%&!"#$%&'()*+,-./0123OSENF NPJOP!"##!$%!&'#!()*!+,)!!"#$!%&'ENVVRF!"#$%&'( ^èìáäéê~i=ak=`ki=c=jéëëáåâi=gk=jk=envvqfk`êáëáë áåíéêîéåíáçåqüéçêó=~åç=ãéíüçççäçöók=pík=içìáë jçëäók eáääi=iki=c=pãáíüi=kk=nvvmk=péäñjå~êé=åìêëáåöw mêçãçíáçå=çñ=üé~äíüoåç=éçkk=kçêï~äâi=`qw=^ééäéíçå C=i~åÖÉK i~åi=ak=ak=nvvnk=jééíáåö=íüé=åééçë=çñ=îáëíçêë ~=éê~åíáå~äk=fåíéåëáîé=`~êé=kìêáåöi=ti=nprjnqtk!"#$ O P! VO V

10 !"#$%&'() NMR The Nursing Experience in a Post-cholecystectomy Elderly Patient at ICU Tsui-ting Liu Yu-chih Ting Tao-fen Hsiung ABSTRACT Biliary tract stone ( choledocholithesis ) is a common disease among the old age. The therapy mainly focuses on the relief of a patient's pain. When complicated with cholecystitis, cholecystectomy is indicated. When it happens to an aged patient, the prognosis after surgery becomes worse with even life threatening risk which needs intensive care. This paper discussed an 88-year-old patient with acute cholecystitis. He was transferred to intensive care unit due to difficult weaning after surgery of cholecystectomy. Based on Goldon's functional of health pattern assessmet, the patient's health problems were identified as: 1. Airway clearance, ineffective; 2. Potential for infection; 3. Sleep patten disturbance; 4. Altered nutrition; 5. Anxiety. In addition to stabilizing the physiologic conditions, through the therapeutic relationship with the patient and his families, the nursing staff also provided aggressive intervention to stabilize the physical imbalance and mental supports for the psychological problems of the old-aged patient, and helped the patient go through the treatment at the intensive care unit easily. The researcher pleasantly present the case for sharing experience in caring such a case with all the staff. (Tzu Chi Nursing Journal, 2003; 2:3, ) Key words: gall bladder stone, elderly patient. Received: July 28, 2002 Revised: October 24, 2002 Accepted: December 23 14, 2002 Address correspondence to: Yu-chih Ting, No. 201, Shei-Pai Rd, SEC. 2, Taipei Taiwan,112, R. O. C. Tel: (02) ! VO V!"#$ O P