照顧一位年長末期腎臟疾病患者初次接受血液透析之護理經驗

本文描述一位年長老人因面對初次血液透析時，內心衝擊無法適應，面臨透析管路放置和生活習慣巨變，而出現哭泣、情緒低落和憂鬱等等負面情緒。護理期間自2014年8月8日至2014年8月16日，透過臨床照護、觀察、身體評估、會談及查閱病歷等方式進行資料收集，運用Gordon 11項功能性健康型態評估，確立護理問題為：體液容積過量、知識缺失、焦慮等三項問題；透過提供水份控制技巧以及搭配藥物來維持平穩的呼吸型態；藉由透析室護理師、營養師以及社工師等跨團隊部門的合作，將透析飲食及生活注意事項錄製成方言發音卡帶，製作放大版飲食圖卡及換藥圖卡，提升個案對疾病的了解及照護能力；安排腎友分享透析歷程及提供社福資源減輕經濟負擔，改善個案之焦慮。期望透過此護理過程協助個案早日適應長期透析生活。

Keywords

血液透析；體液容積過量；知識缺失

Parallel abstracts

The paper described the nursing experience of an elderly patient who was unable to accept emotionally the impacts of hemodialysis for the first time, and unable to adapt to the placement of the dialysis catheter and to life-style changes, as evidenced by crying, depression and other negative emotions. The period of nursing care was from August 8 to 16, 2014. The data were collected through clinical care, observation, physical assessment, interviews and chart reviews. Based on Gordon's 11 Functional Health Patterns, three care problems were identified: fluid volume overload, knowledge deficit and anxiety. The author controlled fluid intake and administered medication to maintain the patient's regular breathing patterns. The author coordinated a multidisciplinary team consisted of dialysis nurses, dietitians and social workers, which produced an education video in the patient's dialect about dialysis, diet and daily life care. A large version of diet and wound care picture cards was produced in order to enhance the patient's ability to understand the disease and self-care skills. In order to ease the patient's anxiety, the team arranged for dialysis patients to share their experiences and provide social support. The team also provided resources to relieve the patient's economic burden. It is desirable that the nurse, through the nursing process, assists the patient to adapt to long-term dialysis as soon as possible.