運用運動訓練改善一位年輕血液透析病人活動無耐力之護理經驗

國人平均每三人就有一人罹患高血壓，血壓若控制不佳可能引發腎臟疾病，嚴重者甚至需接受血液透析治療；長期的透析治療會引發病人出現貧血、尿毒症狀、電解質不平衡、神經病變及體內胺基酸不足等現象，且會因為肌肉耗損及骨病變等原因，導致身體活動度改變及造成肌耐力不足；研究顯示運動能有效改善病人身體活動功能、營養狀況、降低心血管疾病危險因子、避免產生心理問題及促進健康。本文旨在探討運用運動訓練改善一位年輕血液透析病人活動無耐力之護理經驗，筆者於2019/05/01-10/31照護期間藉由觀察、會談、傾聽等技巧，進行主、客觀健康相關資料收集，並運用Gorden十一項功能性健康模式為評估指引，歸納主要護理健康問題為活動無耐力、焦慮、體液容積過量。在照護過程中確立個案護理健康問題，藉由提供個別性護理措施及飲食衛教，偕同復健師與個案討論協調，擬出更具個別性運動訓練計畫。為確保個案運動訓練之安全性，衛教個案注意運動場所的安全性及適當使用護具，並鼓勵其表達內心感受，減輕焦慮，恢復正向思考，使其能增強自信心，克服心理障礙，最終能重新找到生命的意義與價值；期盼藉由此經驗能提供護理人員作為日後照顧類似病人之參考。

關鍵字

運動訓練；活動無耐力；血液透析

並列摘要

The information indicates that one out of every three people in the country suffers hypertension. The improper control over the blood pressure may cause kidney disease; the patient with the severe condition need to take the hemodialysis treatment. The patient who receives the hemodialysis treatment in the long-run will cause anemia, a symptom of uremia, water-electrolyte imbalance, neuropathy, and insufficient amino acid inside the human body. Also, it may cause muscle strain and renal osteodystrophy, which lead to the insufficiency of physical activities and muscular endurance. Research shows that to take certain exercise can effectively improve the function of a patient's physical activities and the nutritious status, and decrease the risk factors of cardiovascular disease, avoid the psychological problems, and promote the health of the body. This research aims to explore and discuss the nursing experience of improving the young patient's activity intolerance under the hemodialysis treatment through exercise training. The period was from 2019/05/01-10/31. The author applied the technique of observation, chatting and listening to the patient to implement the subjective and objective health-related data collection. The author also used Gordon's 11 functional health patterns as the nursing diagnosis and principle, and categorized the main nursing issues as activity intolerance, anxiety, and body fluid overload. During the period, the author took care of the patient and confirmed the patient's nursing and health issues through providing individual nursing actions and the health education of diet, along with the rehabilitation technician and the patient to work out the specific exercise training and planning particularly. In order to assure the patient's safety while taking the exercise, the health education was to help the patient keep the eyes on the selection to the appropriate location and wear the protective gear properly. It also encouraged the patient to freely express what was on his mind to alleviate the anxiety, to go back to the positive thinking, to enhance his self-confidence, and to overcome the mental barrier. Finally, the patient could relocate the meaning of life and value. It is hoped that the study can be helpful for nursing people and serve as a reference when someone may have the chance to take care of patients in a similar condition.

並列關鍵字

sport training ； activity endurance ； hemodialysis

參考文獻

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