運用Watson關懷理論照護一位急性腎損傷病人之加護經驗

本文為一位因長期忽略本身慢性腎臟病問題，導致急性腎損傷合併肺水腫瀕臨呼吸衰竭之年長女性，入加護病房治療期間面臨疾病的快速惡化，感到生命備受威脅而感到焦慮，又因過往家人透析有不好的經驗，一度拒絕透析治療，引發筆者探討之動機。護理期間2020/12/20至12/30，依生理、心理、社會、靈性層面評估，藉由直接照顧、會談、觀察、身體評估及病歷查閱等方式，確立個案有體液容積過量、焦慮、無效性健康管理等健康問題。筆者運用Watson關懷理論中之照護概念進行護理，照護期間紀錄每日輸出輸入量是否平衡，嚴謹水分控制減少液體滯留；澄清對血液透析的錯誤認知；藉由關懷、同理心進而建立良好的護病關係，減少疾病對身、心理的衝擊，最後個案生命徵象逐漸趨於穩定，順利轉出加護病房。而本文個案被診斷慢性腎臟病之加護時期，主要著重於急性期之治療與照護，未能持續性對個案及家屬強化疾病認知、回覆施教並追蹤後續返家後自我健康管理情況。建議未來類似個案能進行個案管理系統機制，亦可運用雲端就醫資料建構溝通平台，讓醫院與診所的治療計畫做無縫接軌，進而持續性完成治療計畫及健康管理之追蹤，以維持慢性腎臟病病人照顧的連續性，最後期望此護理經驗能做為日後相關人員照護參考。

關鍵字

急性腎損傷；體液容積過量；焦慮；無效性健康管理

並列摘要

This article is about an elderly woman with acute kidney injury and pulmonary edema and was on the verge of respiratory failure due to long-term negligence of her chronic kidney disease. She faced the rapid deterioration of the disease during treatment in the intensive care unit, and felt her life being threatened and suffered from anxiety. Due to negative experience of dialysis from her family members previously, she had refused dialysis treatment for a while, which triggered the motivation of the author to discuss this case. During the nursing period, from December 20th to 30th in 2020, according to the physical, psychological, social and spiritual evaluation, through direct care, interview, observation, physical evaluation and medical record review, and so on. It is confirmed that the case has excessive body fluid volume, anxiety, ineffective health management and other health problems. The author uses the nursing concept in Watson's theory of care to provide nursing care. During the nursing period, the daily output and input are recorded for daily balancing purpose, strict water control is used to reduce fluid retention; clarify the misunderstanding of hemodialysis; establish a good nursing care through caring and empathy in order to reduce the physical and psychological impact of the disease. In the end, the patient's vital signs gradually stabilized and were transferred out of the intensive care unit smoothly. During the intensive care period in this case diagnosed with chronic kidney disease was mainly focused on the treatment and care in the acute stage, but failed to continuously strengthen the disease awareness to the case and her family members. Neither was any attention paid in responding to the teaching and tracking for the follow-up of self-health management after returning home. It is recommended to implement a case management system mechanism for similar cases in the future, and also use cloud-based medical data to build a communication platform, so that the treatment plans of hospitals and clinics can be seamlessly integrated. Hence complete the treatment plans and health management tracking without interruption, as well as maintaining the continuity of care for patients with chronic kidney disease. Finally, it is hoped that this nursing experience can be used as a reference for the care of relevant personnel in the future.

並列關鍵字

acute kidney injury ； fluid overload ； anxiety ； ineffective health management

參考文獻

白雲芳、曾雅燕、胡憶芳、江鉅源（2019）．一位急性肺水腫病人接受連續性腎臟替代治療之加護經驗．弘光學報，83 ，25-37。https://doi.org/10.6615/HAR.201903_(83).0002

周怡靚、張蕙明（2017）．急性呼吸衰竭病人於呼吸器脫離過程情緒焦慮之照護經驗．呼吸治療，16(2) ， 50-50 。 https://doi.org/10.6269/JRT.2017.16.2.20

林麗卿、邱艷芬、林碧珠（2017）．家屬叮嚀方案對減輕加護病人焦慮和非計畫性拔管之成效．護理雜誌， 64(5) ， 41-49 。 https://doi.org/10.6224/JN.000067

唐敏華、李文欽、丘周萍（2019）．探討慢性腎臟病患者衛教介入措施對其自我管理、生活品質及生理數值控制之長期追蹤．台灣公共衛生雜誌，38(2)，203-214。https://doi.org/10.6288/TJPH.201904_38(2).107114

連澤仁、施君儒（2020）．慢性腎臟病與糖尿病-臨床上如何處理此共病症．臨床醫學月刊，85(5)，299-315 。 https://doi.org/10.6666/ClinMed.202005_85(5).0055

主題瀏覽