Overview of Liver Transplantation
Liver transplantation is a surgical procedure to remove a diseased liver that has lost its function when liver disease has progressed to an advanced and life-threatening stage, and then implant a healthy liver into a person so that liver function can be restored. Currently, liver transplantation has become the most ideal treatment for end-stage liver disease. However, due to the complexity and long duration of liver transplantation surgery, the many postoperative complications and the application of immunosuppressive drugs, therefore, correct, perfect and considerate nursing interventions are of great significance to the recovery of liver transplant patients.
Main nursing problems
1. Adverse emotions such as fear and anxiety.
2. Potential complications, such as infection, bleeding and rejection.
Nursing measures
1.Psychological care
Liver transplant patients are not only in a state of crisis physically, but also often have adverse emotions such as anxiety, nervousness, fear and depression due to the worry that the excessive surgical fees will burden the family. Therefore, the nursing staff should care, encourage and comfort the patients, patiently explain the knowledge about the disease and the necessity of liver transplantation to the patients, so as to make them have a preliminary understanding of the operation, make full psychological preparation, and avoid the patients’ uncooperative behavior due to excessive concern about the operation.
2. Preoperative preparation
Evaluate various physiological conditions of the patients before the operation; instruct the patients to master the methods of deep breathing and effective sputum coughing; do the blood-matching experiment and prepare the skin 1 day before the operation; perform intestinal irrigation in the evening of 1 day before the operation and in the morning of the day of the operation; and prohibit food and water for 8 hours and 4 hours before the operation respectively.
3. Observation of condition
After surgery, observe the patients’ mental changes, closely monitor the changes of respiratory system, cardiovascular system, central nervous system, liver and kidney functions, and record the urine output every hour to monitor the balance of in and out.
4.Skin care
Prevent localized pressure during the period of lying in bed, apply air mattress bed, put soft pillow on the bone protruding part, wipe the whole body of the patient with warm water regularly, and change clothes and pants in time to prevent pressure sores from arising.
5. Drainage tube care
The patients have more tubes after the operation, after returning to the monitoring room, they should check carefully with the doctor, fix the drainage tube properly, and prevent the tube from coming out. Keep the drainage tube smooth, avoid bending, pressure and twisting, and squeeze the abdominal drainage tube once an hour to prevent blockage. Closely observe the nature, color and amount of drainage fluid, and keep the skin around the drainage tube clean.
6.Complications care
(1) Infection Due to the application of immunosuppressant and surgical anesthesia after liver transplantation, it is easy to combine various kinds of infections, and the patients should be protected and isolated after the operation, and the room should be ventilated and disinfected in the morning and at night every day. Medical staff and family members should wear isolation clothes and shoe covers, and wear isolation hats and masks before entering the hospital room, and family members suffering from colds and other infectious diseases should refuse to visit the patients. Closely monitor temperature changes, if the temperature exceeds 38℃, especially when accompanied by chills, nausea, vomiting, diarrhea, rash and other symptoms, the doctor should be notified immediately.
(2) Bleeding Observe the color, amount and character of the abdominal drainage fluid and the skin of the puncture point. If there is much drainage fluid 24～48 hours after operation, blood oozing around the puncture point, petechiae increase in size, and the patient suddenly feels severe pain in the liver area of the graft with localized pressure pain and rebound pain, etc., the doctor should be notified to give the treatment in a timely manner.
(3) Rejection reaction Acute rejection reaction mostly occurs in 1~2 weeks after operation, patients’ liver function and biochemical indexes, body temperature, mental state and other changes should be closely observed, if fever, chills, malaise, anorexia, hepatic pain, jaundice, blood bilirubin and hepatic enzymes rise sharply, doctors should be notified and given treatment immediately.
7.Nutritional support nursing
Encourage the patients to eat before operation, with a balanced mix of protein, glucose, fiber and vitamins in the diet. For those who have insufficient intake of food through mouth, parenteral nutrition can be performed according to medical advice. Postoperative nutritional supplementation generally follows two principles, i.e., supplementation according to liver function status and early feeding from the gastrointestinal tract.
8. Medication care
Follow the doctor’s instructions to arrange medication in a planned and rational way, and observe the efficacy and adverse reactions of the drugs. In case of drug conflicts, first ensure the punctual application of immunosuppressants, followed by anti-infective drugs and anticoagulant or hemostatic drugs.
Health promotion
1. Appropriate easy exercise such as walking, tai chi, etc. after discharge from the hospital, do not engage in strenuous exercise.
2. Quit smoking, drinking and other bad habits.
3. Ensure adequate sleep.
4. Pay attention to hygiene, clean the skin, protect the wounds, change the clothes, keep the mouth clean, brush the teeth in the morning and evening, rinse the mouth after meals.
5. Eat a reasonable diet, eat more vegetables, fruits and other foods rich in vitamins, and eat less pickled and fried foods.
6. Take medication as prescribed by the doctor and have regular follow-ups. If any abnormality occurs, you should consult the doctor in time.