一位腹膜透析患者因便秘導致腹膜炎之護理經驗

本篇旨在探討一位接受腹膜透析治療病人，因對腹膜透析飲食控制原則不清楚，蔬果攝取不足，產生低血鉀及長期便秘，造成腸道通透性改變而導致腹膜炎之護理經驗。護理期間自2012/2/6至2012/2/27，筆者經由觀察、會談、身體評估與病歷查閱，並運用Gordon十一項功能性健康型態評估等技巧收集資料，加以分析整理，以確立個案問題。在護理過程中發現個案有因腹膜炎引起之體溫過高、急性疼痛、焦慮及知識缺失等健康問題。筆者經過完整的護理評估後，主動給予關懷、運用同理心及建立良好的護病關係，提供個別性護理措施，改善其生理問題，並運用醫療團隊合作模式來提供正確的相關知識及護理指導以減輕其焦慮感，成功導正個案對於引發腹膜炎導因之錯誤認知，正確矯正個案不良的蔬果攝取方式，重新學習居家預防照護，加強自我照顧能力，以預防腹膜炎再度發生。筆者期望藉此護理經驗，以做為臨床照護此類個案的參考，亦提醒醫護人員應謹慎且整體性評估病人罹患腹膜炎之導因，有效降低腹膜炎之發生率，提升病人透析品質及效率。

關鍵字

腹膜炎；腹膜透析；便秘；低血鉀

並列摘要

This case report investigates the nursing experience of a patient undergoing continuous ambulatory peritoneal dialysis (CAPD) unfamiliar with dietary principles and had an insufficient intake of fruits and vegetables. This led to chronic hypokalemia and constipation that resulted in peritonitis due to changes in intestinal permeability. Nursing care was conducted from February 6, 2012 to February 27, 2012. Data was collected though observations, interviews, physical evaluations and review of hospital records. By using Gordon's 11 functional health patterns along with data analysis, the author was able to identify the following patient problems during nursing care: high fever, acute pain, anxiety and lack of health knowledge. After a thorough nursing evaluation, the author took the initiative by showing care and solicitude to the patient. Compassion was used to build a strong nurse-patient relationship, and provide individualized nursing care that improved the physical problems of the patient. Collaboration with the medical team to provide the patient with knowledge and nursing guidance reduced the patient's anxiety. This proved successful in correcting the patient's faulty knowledge on the cause of CAPD-related peritonitis and also corrected the patient's bad habits on not eating vegetables, helped the patient re-learn preventive home care measures, and enhanced his self-care capacity to prevent the future recurrence of peritonitis. The author hopes that this nursing care experience can be used as a future reference for similar cases, and remind health workers that a careful and thorough evaluation of patients experiencing peritonitis will lower its incidence while also improving patient's dialysis quality and efficiency.

並列關鍵字

peritonitis ； peritoneal dialysis ； constipation ； hypokalemia

參考文獻

裘苕莙、陳育弘、陳佩盈、蘇逸玲（2010）．暫時性血液透析導管血流感染相關因素探討．榮總護理，27（2），127-135。doi: 10.6142/VGHN.27.2.127

Mizuno, M., Suzuki, Y., Nonaka, K., Sei, Y., Maruyama, S., Matsuo, S., & Ito, Y. (2013). Perforative peritonitis caused by appendicitis in a patient on peritoneal dialysis. Internal Medicine, 52: 1177-1181. doi: 10.2169/internalmedicine.52.9196

李明芳（2009）．特殊族群透析患者飲食原則．2009 年 6 月 17 日取自 http: // www.cgmh.org.tw/cgmn/category_s.aspid_seq＝0905022