照顧一位血液透析多年患者遭逢喪失女友之護理經驗

Nursing Experience of Taking Care of a Hemodialysis Patient Who has Lost His Girlfriend

陳沛其(Pei-Chi Chen) ； 何牧行(Mu-Hsing Ho)

《臺灣腎臟護理學會雜誌》 17卷2期 (2018/06) Pp. 89-103

https://doi.org/10.3966/172674042018061702007

摘要

本文是探討一位49歲血液透析患者已接受透析治療31年，近來因遭逢喪失女友後所引起的心理調適障礙之護理經驗。護理期間由2016年7月18日至2016年9月16日，藉由「羅氏適應模式」為評估工具，運用觀察、會談、身體評估、傾聽、使用問卷量表及病歷查閱等方式收集主、客觀資料，確立個案有「體液容積過量」「營養狀況不平衡／少於身體所需」及「調適障礙」等問題，筆者在護理過程中陪伴個案經歷悲傷過程，主動關懷，運用同理心，傾聽個案感受，給予適當的護理措施，製作飲食紀錄表和個案共同討論水分控制的注意事項，進而改善體液容積過量及透析中低血壓的產生，利用迷你營養評估量表（Mini Nutritional Assessment, MNA）評估其營養狀況，使其了解飲食管理方法而改善營養不良，並引導說出內心的感受與想法，透過聆聽音樂及宗教信仰的介入，來減輕負向情緒，讓個案重新適應女友不在的環境及將情感投注在生活上，提升個案自我照顧能力及生活品質。

關鍵字

羅氏適應模式 ； 體液容積過量 ； 調適障礙

並列摘要

This article explored the nursing experience of a 49-year-old hemodialysis patient who has undergone dialysis for 31 years and has recently suffered a psychological adjustment disorder due to the loss of his girlfriend. During the nursing period, from July 18, 2016 to September 16, 2016, the ＂Roy Adaptation Model＂ was used as the assessment tool to collect the data of the subjects from the observation, talks, physical assessment, listening, objective information, it was established that the patient suffered from ＂excess fluid volume,＂ ＂nutritional imbalance / less than the body needs＂ and ＂barriers to adjustment＂ issues. During the care period, the author accompanied the process of grief, actively showed care, listened to the feelings of the patient, provided appropriate nursing care measures, made food records and discussed water control with case, thereby improving the control of body fluid volume and hypotension due to dialysis, employed the use of Mini Nutritional Assessment (MNA) scale to assess the patient's nutritional status, understand diet management methods to correct malnutrition, and provided encouragement for him to speak out his feelings and thoughts; used listening to music and religious intervention to alleviate the negative emotions, to enable the patient to adapt to life without his girlfriend, to focus in his life, to improve his ability of self-care and his quality of life.

並列關鍵字

Roy adaptation model ； excess fluid volume ； barriers to adjustment

參考文獻

林惠敏、劉詩玉（2016）‧糖尿病合併慢性腎臟病的營養預防和治療‧腎臟與透析，28（2），84-89。doi: 10.6340/KD.2016.28(2).08

吳紅蓮（2015）‧透析病人殘餘腎功能之重要性-控制飲食的鹽分及水分之應用‧腎臟與透析，27（2），98-102。doi: 10.6340/ KD.2015.27(2).12

陳慧芬（2013）‧血液透析病患之素食飲食原則與常見的營養問題‧腎臟與透析，25（4），320-324。doi: 10.6340/ KD.2013(4).12

徐邦治、江守山、黃志銘（2002）‧實用準則（I）－成人慢性腎衰竭營養臨床‧腎臟與透析，14（2），89-96。doi: 10.6340/KD.2002(2).09

白玉玲、丘周萍（2011）‧血液透析患者體液容積過量的照護‧源遠護理，5（1），5-10。doi: 10.6530/YYN.2011.5(1).01