照顧一位初次接受血液透析的茹素病人之護理經驗

The Nursing Experience of Caring a Vegetarian Patient who Receives His First Hemodialysis Treatment

林姵妘(Pei-Yun Lin)

《長庚護理》 28卷3期 (2017/09) Pp. 562-573

https://doi.org/10.3966/102673012017092803016

摘要

本文旨在描述照護一位初次接受血液透析個案，因攝取蛋奶素導致低蛋白與高血磷的問題，同時因面臨透析產生無望感之護理經驗。護理期間為西元2015 年4 月24 日至7 月3 日，筆者藉由觀察、會談、傾聽、檢閱病歷等方式收集資料，並以Gordon 十一項健康功能評估進行整體性評估及分析，確立護理問題為：潛在危險性感染、營養不均衡：少於身體需要、無望感。照護過程中，筆者運用主動關懷，先與個案建立良好信任關係，再經序漸進予護理指導，運用手機撥放影片來教導暫時性雙腔靜脈導管傷口照護技巧；收集個案飲食習慣後與個案共同討論修正飲食採高蛋白低磷飲食，並協助製作「磷／蛋白質」比值小於20 的茹素食譜等；此外，在面臨透析而感到無助時，適時陪伴與提供心理支持，傾聽並瞭解其需求，鼓勵其表達內心感受，坦然面對生活進而重建正向人生觀，並重新規劃未來生活的藍圖。

關鍵字

初次血液透析 ； 茹素 ； 無望感

並列摘要

This paper describes the nursing experience of taking care of a patient who receives the hemodialysis treatment for the first time and has low protein and hyperphosphatemia problems because of lacto-ovo vegetarian eating habit. The felt hopeless while receiving hemodialysis treatment. The nursing period started from the 24th of April the 3rd of July in 2015. Data were collected through physical observation, interview,listening, and medical Records review. Overall assessment and analysis were carried out by use of Gordon eleven functional health assessment. The nursing problems inlcuded potential risk of infection, imbalanced nutrition-less than body needs, and hopelessness. During the nursing, active cares were utilized to establish a good trust relationship with the patient and nursing guides were provided gradually. The author used videos played by a cell phone to teach the patient how to take care of temporary duallumen catheter wound. The author discussed eating habits with the patient and suggested how to modify the diet to a high-protein and low-phosphorus one, assisting the patient to to recreate vegetarian recipes with a ＂phosphorus/protein＂ ratio less than 20. Moreover, when the patient felt helpless while receiving hemodialysis treatment, the author provided timely accompany and psychological support, listened and understood the patient’s needs, and encouraged the patient to express the feelings, to face the reality of life, to rebuild a positive view of life, and to re-plan for the future.

並列關鍵字

first-time hemodialysis ； intake vegetarian food ； hopelessness

參考文獻

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