照顧一位慢性腎臟病患者接受腹膜透析之護理經驗

本文為協助一位雙親皆為血液透析治療患者的年輕已婚婦女，在慢性腎臟病（chronic kidney disease，CKD）疾病治療過程中，個案面臨腎臟替代療法抉擇、接受腹膜透析的治療過程，如何透過溝通協調讓家人瞭解及接受並取得支持與配合。筆者為個案之腎臟病衛教護理師，於2012年4月12日至2012年8月6日期間，運用羅氏適應理論進行整體性的評估，發現個案有焦慮、抉擇衝突、健康尋求行為及潛在危險性感染等健康問題。藉由給予適切、整體性及連續性的護理照護措施，以傾聽、主動關懷及支持來協助個案面對長期透析；在照護期間適時給與鼓勵及協調醫師給予問題釐清，克服生理的問題及心理的障礙，順利與安全地進入透析治療，並以健康的態度面對未來長期的透析生活。

關鍵字

慢性腎臟病；腎臟替代療法；抉擇衝突

並列摘要

The subject is a young married woman with chronic kidney disease (CKD) whose parents were both on hemodialysis. This report described how communication and coordination was used to gain the support and understanding of her family when she was faced with choice of renal replacement therapy or Tenckhoff catheter implantation for peritoneal dialysis (PD). Between April 12 and August 6, 2012, the author, a CKD education nurse, found through global evaluation using Roy adaptation model that the patient was experiencing health problems such as anxiety, conflicting choices, health seeking behavior and potential infection risks. Through suitable, comprehensive and continuous nursing care measures such as listening, active care and support, we assisted the patient with receiving the facts on long-term dialysis, accepting her choice of dialysis modality and actively engaging in PD self-care. Through timely encouragement, explanation by doctors and clarification of problems, the physical and psychological problems were overcome. The patient was able to enter dialysis treatment successfully without incident and approach the prospect of living with long-term dialysis with a healthy attitude.