一位血液透析病人合併周邊動脈阻塞截趾之護理經驗

Nursing Experience of Hemodialysis Patient with Peripheral Arterial Occlusive Disease after Amputation

翁妙妃(Miao-Fei Weng)

《臺灣腎臟護理學會雜誌》 13卷4期 (2014/12) Pp. 53-68

https://doi.org/10.3966/172674042014121304005

摘要

本文探討一位血液透析病人因周邊動脈阻塞（peripheral arterial occlusive disease, PAOD），導致左腳第1∼3趾切除之護理經驗。筆者於2012年11月5日至同年12月14日，藉由身體評估、觀察、直接照護、會談及整體性評估等技巧收集資料與個案建立互信關係，發現個案因罹患PAOD截趾後，其傷口的疼痛造成個案飲食、睡眠的改變，且日常生活活動需由案妻協助完成，經濟上又須依靠兒子負擔，導致個案出現意志消沉及情緒低落的現象；歸納其主要護理問題為急性疼痛、營養不均衡：少於身體需要、無望感。在照護過程中，主動關懷個案並與個案建立良好的護病關係取得個案信任，運用緩解疼痛技巧使個案減輕截趾肢體的疼痛不適；製作高蛋白飲食鑰匙圈提供案妻採買食物參考、並指導案妻改變烹調方式，讓個案攝取有效的營養使白蛋白指數升高；運用親子間互動關懷，協助個案走出無望的深淵與調適截趾後的生活型態，並引導個案發現自我存在的價值感，重建正向自我的觀念，且坦然的面對生活。

關鍵字

周邊動脈阻塞 ； 血液透析 ； 截趾

並列摘要

This subject of this article was a hemodialysis patient who underwent amputation of his left first to third toes due to peripheral arterial occlusive disease (PAOD). The author evaluated the patient through physical assessment, observation, nursing care and communication between November 5 and December 14, 2012. The author worked with the caregiver and used all available resources in order to build up trust with the patient. The report found out that wound pain after the amputation forced the patient to change his eating and sleeping habits. As he also needed his wife's help with daily activities and was economically dependent on his son, the patient became clinically depressed. In this case, there were some key issues including acute pain, inadequate nutritional intake and hopelessness. During the care process, the author actively engaged with the patient and established a good nurse-patient relationship. Pain relief techniques were used so that the patient felt less pain and discomfort with the amputation limb. The author also informed the patient's wife on he importance of a high protein diet. A high-protein diet key ring was crafted to provide the patient's wife with a reference for grocery shopping. By also instructing the wife on changing her method of cooking, this helped improve the patient's nutritional intake and raised his albumin level. Gradually, family interactions and assisted care helped the patient emerge from the pit of despair and adapt to the post-amputation lifestyle. The patient was also given guidance on finding his own value, rebuilding a positive self-image and accepting his life.

並列關鍵字

peripheral arterial occlusive disease ； hemodialysis ； amputation