照顧一位長期腹膜透析病人面對透析模式改變調適之護理經驗

本文個案是一位接受腹膜透析治療多年的女性，感染腹膜炎期間暫改血液透析治療，治療後在期待中預重新植管時，因嚴重腹膜沾黏被告知不再適合腹膜透析，個案在無心理準備下被迫接受透析模式改變，除了要重新學習透析照護外，生理、心理、家庭生活及生活型態也必須有所調整，而引發一連串問題；護理期間自2016年4月29日至6月29日，筆者依據Gordon十一項功能性健康型態進行評估，運用身體評估、觀察、會談、查閱病歷等方式收集資料，確立個案有潛在危險性感染、體液容積過量與調適障礙等健康問題。透過個別性護理措施，給予留置導管照護、水份控制技巧等相關衛教，並藉由醫護人員、家人及腎友的社會性支持，有效幫助個案渡過調適過程。建議未來應加強在職教育訓練，不定期舉辦案例討論會，增加護病溝通課程，使護理人員日後面對類似案例時，更能有效協助患者渡過透析模式改變調適過程，希藉此成功案例作為臨床照護之參考。

關鍵字

腹膜透析；血液透析；調適障礙

並列摘要

This article described the nursing care experience and a coping process of a long-term peritoneal dialysis female patient who received a temporary hemodialysis due to peritonitis complications. With little preparation for hemodialysis, the patient had to adapt to physiological and psychological changes in treatment and in lifestyle. The purpose of this article was to utilize skills and design individual nursing intervention to assist the patient coping with dialysis changes and overcome adjustment difficulties. During the nursing period from April 29 to June 29 in 2016, observation, conversation and physical assessment skills were used to follow Gordon’s 11 multi-functional health scales to gather information and assess the case for health problems, including risk of infection, fluid-volume excess, and adjustment disorder. Individual nursing care interventions were tailored to provide information on perm catheter self-care and water intake control; patients were able to adjust to changes through the social support of medical staff, family and other dialysis patients. Lessons learned from this nursing experience were that in-service education to assist dialysis coping should be strengthened for newly admitted patients, and case conferences were necessary for nurses to obtain communication training. This experience would shed some light to health care providers when caring for long-term peritoneal dialysis patients with modality changes.

並列關鍵字

Peritoneal dialysis ； Hemodialysis ； adjustment disorder

被引用紀錄

張琇祝、許紫燕、陳瑞忻（2023）。一位腹膜透析病人因反覆性腹膜炎轉換血液透析之護理經驗。彰化護理，30(2)，102-113。https://doi.org/10.6647/CN.202306_30(2).0012

林玉菁、林庭㚤、林郁蘋、蔡瑋瑋、蘇芳儀（2023）。降低腎臟科病房腹膜透析病人腹膜炎發生率。長庚護理，34(3)，60-73。https://doi.org/10.6386/CGN.202309_34(3).0006

張雅琪、吳培寧、林玉菁、王惠貞（2020）。照顧一位慢性腎病之護理經驗。長庚護理，31(2)，241-252。https://doi.org/10.6386/CGN.202006_31(2).0009

謝靜伊、孫婉娜（2024）。照顧一位轉換透析模式且傷口癒合不佳病人之護理經驗。領導護理，25(1)，82-95。https://doi.org/10.29494/LN.202403_25(1).0007

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照顧一位長期腹膜透析病人面對透析模式改變調適之護理經驗

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