- 期刊
照顧一位轉換透析模式且傷口癒合不佳病人之護理經驗
Nursing Experience from Caring for a Patient who Switched to Dialysis Mode with Poor Wound Healing
摘要
本文探討一位43歲女性，為腹膜透析個案因腹膜炎無法控制下，導致透析模式需轉換為血液透析，期間因飲水及飲食控制不佳下出現體液容積過量之健康問題，為進行長期血液透析而放置的左手動靜脈瘻管，因傷口癒合不佳，出現血管通路功能失效之健康問題，個案因為透析膜式的改變，生活步調驟變，短時間內需要重新學習飲食控制、傷口換藥等技巧，間接造成焦慮的健康問題，引發筆者關注，照護期間為2020年12月9日至2021年1月23日，利用身、心、靈、社會進行整體性評估，確立個案健康問題有體液容積過量／與水份攝取過多及飲食習慣不當有關、血管通路功能失效／傷口癒合不佳有關、焦慮／與透析模式改變有關，與營養師搭配下給予個案飲食指導，並透過病友及自身照護經驗分享，強化個案與疾病共處的信心，使個案住院期間未再發生因飲食不當導致的體液容積過量情況，但筆者擔心個案返家後是否能落實執行，無從追蹤為本次限制，建議往後可導入遠距健康監測，能及時確認飲食適當性及問題解決管道。
並列摘要
This article discusses a 43-year-old female peritoneal dialysis (PD) patient who had to switch her dialysis mode to hemodialysis as her peritonitis was uncontrollable. During this period, she developed health problems of excessive body fluid volume due to poor management of water intake and diet. An arteriovenous fistula was placed in the left arm for long-term hemodialysis, but the patient developed vascular access failure due to insufficient wound healing. Due to swapping dialysis mode, the pace of the patient's life changed suddenly, and she needed to relearn diet control, practice wound dressing change and other skills in a short period of time. These indirectly generate health issues such as anxiety, and hence arouse the attention of the author. The period of care was from December 9 in 2020, to January 23 in 2021, with a comprehensive assessment from the physical, psychological, spiritual, and social aspects and it was diagnosed that the health problems were associated with excess fluid volume as well as excessive water intake and poor diet; impaired vascular access and also poor wound healing; anxiety related to changes in dialysis mode. The dietician provided dietary guidance to the patient and shared previous care experiences to enhance the patient's confidence in co-existence so that the patient stopped developing excessive body fluid volume from poor diet during hospitalization. However, the author is concerned about whether the patient can carry out the measures taught to her after she returns home. The lack of follow-up mechanism was a limitation for this study. It is suggested that remote health monitoring be introduced in the future to confirm proper diet and provide problem solving channels in a timely manner.