一位血液透析個案合併血管通路穿刺困難之護理經驗

Nursing Experience of a Complicated Hemodialysis Case with Complication Vascular Access Puncture

鄧毓庭(Yu-Ting Teng) ； 張淑銘(Shu-Ming Chang)

《領導護理》 24卷3期 (2023/09) Pp. 77-90

https://doi.org/10.29494/LN.202309_24(3).0007

摘要

本文探討一位68歲末期腎臟病之長期血液透析個案，多次血管通路穿刺困難之護理經驗，照護期間自2021年4月1日至2021年5月8日，運用Gordon十一項健康功能型態評估作為護理評估工具，以觀察、傾聽、訪談、身體評估及病歷查閱等方式收集資料，發現個案有急性疼痛、體液容積過量及焦慮等健康問題。透過個別性護理實施，強化自我照顧技能，使個案減輕因穿刺血管通路帶來的疼痛與壓力，經由水份控制、飲食衛教及規則血液透析治療，明顯改善各項生理不適的問題。護理過程中水份控制問題(兩次透析之間水份增加5公斤，約乾體重9.34%（58.5-53.5=5/53.5*100 %=9.34%））已獲得控制；以接納個案負面情緒，傾聽個案心中想法，利用音樂、芳香療法來降低因疾病帶來的焦慮情緒，並在家庭支持系統協助下，幫助個案提升自我存在的價值，以正向積極的態度面對透析生活。

關鍵字

血管通路 ； 急性疼痛 ； 體液容積過量 ； 焦慮

並列摘要

This article discusses the nursing experience of a 68-year-old patient with terminal-stage renal disease from long-term hemodialysis who experienced multiple puncture complication in vascular access. During the nursing period, from April 1 to May 8 in 2021, Gordon's Eleven Health Functions Assessment was used as a nursing evaluation tool. Collect data through observation, listening, interviews, physical assessment, and medical record review. It is identified that the patient had health problems such as acute pain, excessive body fluid volume, and anxiety. Through individualized nursing, strengthening self-care skills, in order to relieve the pain and pressure caused by puncture of blood vessels. Through water control, dietary hygiene education and regular hemodialysis treatment, the physical discomfort was significantly improved. The amount of water increased 5 kg in body was about 9.34 % (58.5- 53.5=5/53.5*100 % = 9.34 %)of the dry weight which was controlled between two dialyses. In order to accept the negative emotions of the case, listen to the thoughts of the case, make use of music and aromatherapy to reduce the anxiety caused by the disease, and with the assistance of the family support system, help the case to enhance the value of self-existence, and face the dialysis life with a positive attitude.

並列關鍵字

vascular access ； acute pain ； fluid volume excess ； anxiety

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