運用行為修正策略協助一位血液透析病患飲食控制與生活壓力適應的護理經驗

The Nursing Experience of Applying Behavior Modification to Help a Hemodialysis Patient to Restrain Diet Intake and Adjust Stress

張慧蘭(Hu-Lan Chan) ； 車憶敏(I-Min Che)

《臺灣腎臟護理學會雜誌》 9卷2期 (2010/12) Pp. 1-13

摘要

本文是敘述一位長期接受血液透析病患，因水份控制和飲食攝取的行為偏差而導致呼吸喘、肺水腫、電解質不平衡，致合併症產生，影響生活品質。護理期間自2008年6月11日至2008年8月31日筆者以Gordon十一項健康功能評估為架構，藉由會談、觀察、病歷查閱，發現個案有三個護理問題：體液容積過量、高磷食物攝取過多與不規則服藥所致的血磷過高不遵從行為、個人因應能力失調。在護理過程中筆者依個案的飲食行為問題和身、心理層面適應問題分別進行護理，以期個案得到整體的照護。在針對個案飲食行為問題筆者運用行為修正的方法，以自我監測、刺激控制、認知重建三種技巧，修正個案對水份的控制及飲食的認知，提昇自我效能，達到行為修正的目的，並成功學習飲食控制的自我管理。另個案的心理、社會及經濟壓力的適應問題，筆者利用個案透析時間給予關懷，並透過社工的介入，協助個案之子尋求資源及工作機會，且鼓勵個案參與團體衛教和腎友經驗的交流，予正向支持，讓個案能有穩定的家庭經濟和正常社交活動，使個案在透析治療的適應提升，達到理想的健康狀態。

關鍵字

血液透析 ； 水份控制 ； 行為修正 ； 飲食控制

並列摘要

This report discusses a hemodialysis patient who was suffering from dispel, pulmonary edema and electrolyte imbalance due to non-compliance with fluid & diet regulation. The complications influence the life quality of the patient. The nursing period was from June 11, 2008 to August 31, 2008. By applying Gordon's eleven health functions evaluation, three nursing problems on the part of the patient related to noncompliance, and poor adjustment ability were noted through interview, observation and chart review, namely: fluid overload, excessive high-phosphate food intake, and medicine taken irregularly, resulting in high levels of serum phosphate. In order to provide integral care, we drafted a nursing plan according to the diet behavior as well as mental and physical adjustment problems. In order to correct the patient's diet behavior problem, we administered behavior modification methods by enhancing skills of self-monitoring, stimulation control and knowledge rebuilding. We also revised the perspective of fluid and diet regulation of the patient. In regard to the mental, social & economic adjustment stress of the patient, in addition to paying particular attention during the hemodialysis period, a social worker helped the patient's son to seek social resources and working opportunity. In order to give positive support and provide stable family economic support and normal social activity, we also encouraged the patient to participate in peer group experience exchanges, successfully improved the adjustment ability of the patient during dialysis therapy and achieved a more ideal health status.

並列關鍵字

hemodialysis ； fluid regulation ； behavior modification ； diet intake