- 期刊
一位局部節段型腎絲球硬化症末期腎病變青少年初次腹膜透析的護理經驗
Nursing experience in caring for an adolescent with focal segmental glomerulosclerosis and end-stage renal disease undergoing peritoneal dialysis for the first time
摘要
本文描述一位18歲青少年因局部節段型腎絲球硬化症引發末期腎病變，初次接受腹膜透析治療之護理經驗。個案因術後身體外觀改變出現哭泣、憂鬱等負面情緒，引發筆者想深入關心及照護的動機。照護期間自2023年7月11日至7月25日，筆者藉由直接照護、觀察、傾聽、會談及查閱病歷及運用Gordon 11項健康功能型態評估等方式收集資料，確認個案主要健康問題有：焦慮、體液容積過量、身體心像紊亂等健康問題。照護期間啟動跨團隊合作模式，擬定個別性的照護計畫，提供腹膜透析相關知識、護理指導與回覆示教，以確認個案執行腹膜透析正確性，提供透析飲食諮詢與衛教，教導正確營養攝取的方式以補充個案營養所需，藉這些方法改善個案體液過多的不適與增進日常生活健康管理的準備度；用傾聽、陪伴、關懷減緩其焦慮，並引導其說出內心感受，驅使參與透析導管照護及討論平時穿搭風格，重建個案身體心像改變困擾的自信心；鼓勵透過手機視訊與好友聯繫，提前聯繫學校透析換液的準備工作，讓個案對重返校園及面對同儕有信心；在持續性照護模式下，使個案在短期內學會獨立執行腹膜透析治療，進而改善其生活品質。建議往後照顧類似個案需加入照顧者心理諮商輔導，讓往後面對此案例時能有更好的因應之道。
並列摘要
This article describes the nursing experience of an 18-year-old teenager who received peritoneal dialysis treatment for the first time due to end-stage nephropathy caused by focal segmental glomerulosclerosis. Due to the change in the appearance of the body after the operation, I was worried about the strange eyes of my peers, crying, melancholy, ignoring people and other negative emotions, which triggered the author to think about the motivation of in-depth care and care. During the care period, The researcher carried out the observations and interviews from July 11 to July 25, 2005 and the collected data were evaluated by Gorden's Health Pattern Typology. The patient suffered from: anxiety, body fluid overload, disturbed body image health problems. Start a cross-team cooperation mode during the care period, jointly formulate individual care plans, provide peritoneal dialysis-related knowledge, nursing guidance and reply instructions, to confirm the correctness of peritoneal dialysis, provide dialysis diet consultation and health education, and teach the correct way of nutrition intake to supplement the nutritional needs of the case, through these Methods: Improve the discomfort of excessive body fluids in the case and improve the readiness for daily health management; reduce their anxiety with listening, companionship, care and support, and guide them to speak out their inner feelings, drive them to participate in dialysis catheter care and discuss the usual style of dressing, and rebuild the body image of the case to change the self-confidence of distress; encourage contact with friends via mobile video, contact the preparation of school dialysis liquid replacement in advance, so that the case can have confidence in returning to school and facing peers; in the holistic and continuous care mode, the case can learn to perform peritoneal dialysis treatment independently in a short period of time, thus improving their quality of life. It is recommended that nursing staff and individual psychological counseling be included in future care, so that we can have a better way to deal with this case in the future.