照顧一位老年血液透析病患多次瘻管栓塞之護理經驗

Nursing for an Elderly Hemodialysis Patient Who Has Received Several Fistula Embolism Treatments

陳麗文(Li-Wen Chen)

《臺灣腎臟護理學會雜誌》 5卷2期 (2006/12) Pp. 7-17

摘要

本文為照顧一位82歲末期腎病變之長期血液透析息者，多次瘻管栓塞住院之護理經驗。筆者自91年12月11日至12月20日期間，為此病患透析之主護人員，護理期間藉由直接護理、觀察及家屬成員會談等方式，並運用Gordon 11項功能及家庭評估進行資料收集。確立個案主要護理問題：1、疼痛／透析時瘻管重覆穿刺、血管通路栓塞、血管通路自我照顧欠佳。2、營養狀況少於身體所需／因長期血液透析、血管通路成染、食物變化少。3、家庭運作過程障礙／無法清楚傳達與接受訊息。病患住院期間與病房護理人員溝通個案透析問題，除提供個案基本的生理需求外，連絡家庭照顧者建立醫療聯絡的溝通方式、與建立家屬間照護問題交班記錄，並利用腎臟疾病護理手冊提升家屬對末期腎病的認知與照顧技巧，及運用瘻管照護手冊、圖片，示教日常生活照護重點，促進家屬維護個案透析管路的能力。住院期間個案血管管路順暢後疼痛問題緩解，家屬在瞭解腎病飲食調配技巧後，多元化食物調配使個案的胃口逐漸的好轉，家屬間也在建立個案醫療問題溝通模式後，有一致性照顧觀念，並能依據護理人員所設計的護理評估表每日進行監測使個案得以如期出院。

關鍵字

瘻管衰竭 ； 栓塞

並列摘要

This paper describes the nursing experience on an 82-year-old hemodialysis patient who was hospitalized for fistula embolism several times. The author was in charge of the nursing care for the patient from December 11-20, 2002 and during that period; data was collected through direct nursing, observation, and talks with family members. It was analyzed with Gordon's Family Evaluation and Assessment. Three major nursing problems were identified: 1. fistula cannulation, embolism of blood access, and insufficient caring for blood access when in pain and during the dialysis treatment; 2. insufficient nutrition intake due to long-term hemodialysis, inflection of blood access, and less variety and food choice; 3. family dysfunction/inability to communicate and receive messages. Through the analysis of dialysis problems during hospitalization and nursing, we were able to meet the basic physical and psychological demands of the subject as well as establish medical contacts with the care giver at home in order to improve the awareness and caring skills of family members. The family was also given an end-stage renal disease handbook, and taught how to clean and maintain dialysis catheters and fistula photos to demonstrate points for daily caring. During hospitalization, the subject experienced pain because of the smooth circulation of the blood processing system. In addition, after understanding the skills to prepare food for the patient with renal disease, family members prepared food in greater varieties to satisfy the patient's appetite. Family members have acquired consistent nursing concept after establishing a communication model for medical problems. It allowed them to conduct daily monitoring in accordance with the nursing evaluation and assessment table designed by nurses and help the subject to be discharged from the hospital as scheduled.

並列關鍵字

fistula failure ； embolism