- 期刊
照顧一位慢性腎臟病初次接受血液透析患者之護理經驗
Nursing Care Experience of a First Hemodialysis Patient with Chronic Kidney Disease
摘要
本文探討一位56歲男性原本為慢性腎臟病第二期患者，因腎功能突然惡化為第五期，而接受初次血液透析治療之照護經驗。護理期間自2013年11月6日至11月30日。筆者經直接護理、觀察、會談及電訪等方式蒐集資料，運用羅氏適應模式評估與分析，發現個案主要的護理問題有：體液容積過量、調適障礙、知識缺失。其中調適障礙對個案治療過程影響甚鉅。緣此，筆者在護理過程中，運用主動關懷與個案建立良好的護病關係，以傾聽、不批判的態度看待其在過程中的拒斥心態，強化個案正向認知，陪伴他度過初為血液透析患者之心理調適。接著教導其水分控制知識，使其能有效控制水分攝取，避免體液容積過量之併發症再度發生，另也反覆衛教透析飲食和營養照護之重要性，請個案與家屬以手機拍照飲食內容，作為精確紀錄、討論與修正飲食內容的憑依。同時，進一步釐清調適障礙的困難來源，提供相關訊息及成功案例，使其更能以正面態度面對透析治療帶來之衝擊，以達良好適應。
並列摘要
This article is to discuss the nursing care experience for a 56-year-old male patient, who had stage II Chronic Kidney Disease at first that worsened to stage V due to rapid renal function deterioration and is currently undertaking hemodialysis. The author collected data through direct care, close observation, interview, and phone interviews techniques and assessed the patient by means of Roy adaptation model during the nursing care period from November 6th to 30th, 2013. It was established that the patient's major nursing problems were: excess fluid volume, impaired adjustment and lack of knowledge. Impaired adjustment had a great impact on the patient's treatment process. As result, during the nursing care process, the author took the initiative to show care and managed to establish a good caretaker-patient relationship. The author was empathic and non-judgemental towards the patient, using positive reinforcement to guide the patient through the initial adjustment period of becoming a hemodialysis patient. Then, the patient was educated on the water intake methods to effectively control vascular fluid for preventing complications. Furthermore, the author also repeatedly educated the patient on the importance of diet as well as nutrition care, asking the family members to accurately record the patient’s diet with smartphone camera for further discussions with the author and modifying the patient's diet. Finally, in order to investigate and reduce the patient's anxiety, the author kept providing the patient successful case experiences and related information, enabling him to face the treatment process with positive attitudes and to achieve good adaptation to hemodialysis treatments.