照護一位急性腎衰竭個案之加護護理經驗

本文是照顧一位52歲的中年女性急性腎衰竭，經歷急救插入氣管內管及施行緊急腎臟替代治療，轉入加護病房加護護理經驗，護理照顧期間於2013年3月12日至3月18日，運用Gordon十一項健康功能性評估為指引，經實際參與照護、會談、觀察及查閱病歷等方式進行資料收集。確立個案護理健康問題有體液容積過量／與急性腎衰竭引發體液滯留有關、健康維護能力改變／缺乏急性腎衰竭照護認知、焦慮／與健康狀況受到威脅有關等，護理照護期間，經由醫療團隊的合作，提供急性期整體性照護，介入有效的護理措施，維持體液及電解質的平衡，使個案能及時獲得疾病治療。面對個案生理不適與預後的不確定感，生命突然遭受重大威脅，出現焦慮、失眠的負面反應，且缺乏急性腎衰竭相關認知，此時適時給予個案主動關懷，運用傾聽、提供情緒支持，運用家庭的支持功能，讓個案有正向的思考方向；並促進家屬參與個案的治療計畫，適當時間給予正確的疾病認知，舒緩了個案焦慮的情緒，獲得休息睡眠。希望藉此護理經驗能提供護理人員之參考，讓類似個案能獲得個別性、整體性的醫療照護，提升護理品質。

關鍵字

急性腎衰竭；腎臟替代性治療；焦慮

並列摘要

This article describes an experience of caring for a 52-year-old female patient with acute kidney failure. The patient experienced endotracheal intubation and emergent renal replacement therapy (RT) and was then transferred to the intensive care unit after emergent interventions. The nursing care period lasted from March 12 to 18, 2013. The data were collected through direct patient care, patient interview and patient observation, and medical record review. With the Gordon's 11-Functional Health Patterns assessment tool, the three major problems were fluid overload/fluid retention associated with acute kidney failure, altered health maintenance/ lack of knowledge about acute kidney failure, and anxiety associated with a threatened health situation. During the acute care period, with collaboration of the care team, the patient received comprehensive care with effective nursing measures; her body fluid and electrolytes were maintained at appropriate levels, and the disease could be treated in time. Facing physical discomfort and uncertain progress secondary to a sudden life threat, the patient appeared to have negative feelings, such as anxiety and insomnia. The patient did not have knowledge about acute kidney failure. Active caring and listening provided emotional support for the Patient. The family's support helped the patient think more positively. By encouraging family members to become involved in the treatment plan and providing correct knowledge of the disease, the patient's anxiety was relieved and able to have a good sleep. By sharing this experience, we hope to help other medical professionals provide patients with individual and holistic medical careimproving nursing quality.