照護一位腎癌病人併發急性腎衰竭首次面臨血液透析之護理經驗

Nursing Care of a Renal Cell Carcinoma Patient Complicated with Acute Renal Failure Who Underwent the First Time Hemodialysis

洪慧君(Huei-Jyun Hong) ； 戴秀好(Shiu-Hao Tai) ； 賴見淑(Chien-Shu Lai)

《榮總護理》 29卷2期 (2012/06) Pp. 159-166

https://doi.org/10.6142/VGHN.29.2.159

摘要

本文係探討雙側腎細胞癌行腎切除術後併發急性腎衰竭首次進行血液透析治療個案之護理經驗。護理期間自2010年2月28日至2010年03月10日，以Gordon十一項健康功能評估為架構，於護理過程中運用身體評估、會談及病歷紀錄等方式收集資料，歸納個案有高危險性感染、體液容積過量、特定與疾病相關的部份知識缺失、營養改變少於身體需求及無力感等健康問題。藉由主動關懷、傾聽個案需求，引導表達內心感受，提供血液透析相關護理指導，使個案生理狀況獲得緩解、無透析治療合併症及感染問題，同時鼓勵參與疾病治療計畫增進其自我照護能力；並透過家人及病友的支持與經驗分享，使其能以正向態度面對透析治療所帶來的生活改變，提升自我價值感，重新面對生命的意義。

關鍵字

腎細胞癌 ； 腎切除 ； 血液透析

並列摘要

The aim of this article is to explore the nursing experiences of a patient with renal cell carcinoma who underwent hemodialysis after partial nephrectomy which was attempted in the first place to preserve his renal function. The period of nursing care was from February 28th to March 30th in 2010. Data was collected under the frame of ”Gordon's 11-item Functional Health Status” with physical examinations, interviews, and daily nursing care. We found that the patient had problems including high risk of infection, fluid overload, lack of knowledge of renal replacement therapy, malnutrition, and the feeling of helplessness. Through individualized nursing care plan, the physical discomfort was relieved, and the complications of hemodialysis declined. With attentive care and providing a listening ear, the knowledge of hemodialysis and self-care improved. The patient was further encouraged to participate in deciding the treatment plan. Under family's support and the sharing of experiences with other patients, the patient acquired a positive attitude toward hemodialysis and was able to face the changes in life.

並列關鍵字

renal cell carcinoma(RCC) ； partial nephrectomy ； hemodialysis