一位腹膜透析患者因闌尾炎導致腹膜炎之護理經驗

本文為一位長期腹膜透析患者因闌尾炎併發腹膜炎之護理經驗。護理期間自2013年9月5日至10月1日，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：急性疼痛、潛在危險性感染、營養狀況改變／少於身體所需及焦慮等健康問題。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，並運用醫療團隊提供正確的相關知識及護理指導以降低感染發生及其焦慮感，針對急性疼痛利用按摩、聽個案喜愛的音樂等放鬆技巧使其疼痛獲得緩解，衛教高蛋白飲食知識使個案能正確攝取營養。藉此照護經驗提供日後臨床護理人員整體性評估病人罹患腹膜炎之導因，適時釐清疑慮，減輕焦慮感，進而能積極正向的面對透析生活。

關鍵字

腹膜透析；腹膜炎；護理經驗

並列摘要

This report describes the experience of nursing care for a peritoneal dialysis (PD) patient who developed peritonitis due to appendicitis. Nursing care was provided from September 5, 2013 to October 1, 2013. Data was collected through 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: acute pain, risk of dangerous infections, nutrition less than body requirements, and anxiety. 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 infections and the patient's anxiety. Relaxation techniques such as massage and listening to his favorite music were found to help dramatically with relieving acute pain. Nurses then gave the patient guidance on the nutritional and dietary details for different modes of dialysis, and accurately enforced diet control. This nursing care experience will hopefully assist clinical nursing staff with comprehensive assessments on the factors leading to peritonitis in patients, clarify doubts and relieve anxiety in a timely manner so the patient can face life with dialysis in a positive, optimistic manner.

並列關鍵字

peritoneal dialysis ； peritonitis ； nursing experience

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