照護一位初次接受血液透析患者之護理經驗

本文為照顧一位末期腎病變54歲初次接受透析患者，筆者於2020年01月09日至02月06日運用Gordon 11項健康功能型態評估及藉由觀察、會談、身體評估及病歷查閱等方法收集個案身、心及社會方面之資料，確立個案主要呈現一、體液容積過量，二、知識缺失：高血磷，三、照顧者角色緊張之健康問題。筆者利用新意的方法來回應個案及案妻的需求，如：身體組成監測儀、控水教具、QR Code衛教天地、透析患者飲食之立式圖卡等，運用多元的衛生教育在知識上，給予個案及案妻有效率及經濟的自我照顧知識及技巧，符合個案可理解的方式衛教，同時利用溝通技巧肯定案妻其正負向的感受，改善案妻緊張不安之情緒，得以增加個案及家屬面對長期透析生活的信心。筆者認為持續的執行衛教及追蹤控制水分和飲食是血液透析患者最困難的，對於初次接受透析患者短時間想改變長期飲食習慣及行為是不容易的事，藉此可提供臨床照顧參考。

關鍵字

末期腎病變；體液容積過量；知識缺失；照顧者角色緊張；多元衛教

並列摘要

This article discusses the nursing experience of caring a fifty-four years old first-time dialysis patient in end-stage renal disease. The author adopted Gordon's Eleven Health Functional Assessment to evaluate the case and collected the patient's physical, mental and social data through observation, interview, physical assessment and medical record review from Jan 9^(th) to Feb 6^(th), 2020. The results showed: firstly, the patient's body fluid was overloaded; secondly, high level of phosphate in blood due to patient's lack of awareness of the dietary control; and thirdly, caregiver (the patient's wife) encounters mental health problem due to anxiety. The author utilized innovative methods to respond the nursing requirements from the patient and his wife, such as using a tool of moisture meter monitoring, innovative water control teaching aids, QR Code health education world, vertical chart of diet of dialysis patients, and so on. In addition, the author uses multi-approach health education knowledge to give the patient and his wife efficient and cost-effective self-care knowledge and skills in line with the way the case can understand. Meanwhile, the author also applied communication skills to acknowledge the wife's positive and negative feelings to reduce her anxiety in order to encourage their positive attitude towards the long-term dialysis life. The author believes that continuous implementation of health education; tracking and control of water, as well as diet are the most difficult tasks for hemodialysis patients. It is not easy for first-time dialysis patients to change life-long eating habits and behaviors in a short time, and this case can provide a reference to clinical care.

並列關鍵字

End-Stage Renal Disease ； fluid overload ； lack of knowledge ； caregiver role strain ； multi-approach health education

參考文獻

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。http://doi.org/10.6530/YYN.2011.5(1).01

江永貞、徐碧秀（2014）．運用行為改變跨理論模式協助一位血透析患者控制飲食以降低血磷之護理過程．臺灣腎臟護理學會雜誌，13(3)，69-81。http://doi.org/10. 3966/172674042014091303006

朱嫦智（2021）．多元創意衛教策略對呼吸器依賴主要照顧者之氣切認知與態度影響探討[未發表的碩士論文 ] ．中山醫學大學。http://doi.org/10.6834/csmu202100041

卓秋萍、張乃彬、黃寶慧、黃惠暄（2017）．運用圖像記憶法降低血液透析病人之高血磷專案．臺灣腎臟護理學會雜誌，16(2)，1-14 。 http://doi.org/10.3966/172674042017061602001

林慧貞、徐邦治（2020）．血液透析相關的心血管疾病－非傳統危險因素探討．腎臟與透析，32(2)，79-82 。 http://doi.org/10.6340/KD.202006_32(2).0006

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