照顧一位血液透析病人無望感之護理經驗

本文個案因透析低血壓影響生活，感到失去對身體的控制感，加上長期慢性病與需終生依賴透析產生無望感引起筆者動機。筆者於2019年9月2日至10月28日護理期間，運用Gordon十一項功能性健康評估工具，收集主、客觀資料，確立個案有體液容積過量、便秘及無望感的健康問題。在生理層面讓個案瞭解適當攝水量之計算，並每日測量體重，有效控制兩次透析間增加的體重，使用藥物及非藥物的方式，協助個案養成每日排便的習慣；在心理層面以貝克無望感量表作為評估工具，運用家庭支持、腎友經驗分享，協助個案面對血液透析帶來的挑戰，建立有效策略面對疾病，提升個案對生活的控制感並積極參與治療，成功適應血液透析的生活，並表達對未來的期待與規劃。

關鍵字

無望感；透析低血壓；血液透析；體液容積過量；便秘

並列摘要

This article describes the patient's poor quality of life owing to hemodialysis hypotension. He felt a sense of loss of motor control. Because of his chronic disease that mandated continued hemodialysis, the patient felt hopeless. Have caused the author's motivation. During the nursing period from September 2 to October 28, 2019, the author used Gordon's 11 functional health assessment tools to collect subjective and objective data to establish the patient's health complications, such as excess fluid volume, constipation, and hopelessness. For physiological improvement, the patient was educated of water intake regulation, daily weight measurement for effective weight control between 2 dialysis sessions, and use of drug- and non-drug methods to help develop a daily bowel habit. For psychological support, the Beck Hopelessness Scale was used as a mental state assessment tool. Family support and nephrologist's sharing of their experience were used to help the patient overcome the challenges from hemodialysis. Basis this study, we recommend establishing effective strategies to cope with disease, improving the individual's sense of control over life and encouraging active participation in treatment, successfully adapting to the changes in daily life effected by hemodialysis, and expressing expectations and plans for the future.

並列關鍵字

Hopelessness ； Dialysis Hypotension ； Hemodialysis ； Fluid Volume Excess ； Constipation

參考文獻

王蔚芸、陳美容（2009）‧體液容積過量之原理背景及護理‧長庚護理，20（3），334-342。http://doi.org/10.6386/CGN.200909_20(3).0005

李宗倫、林志慶（2019）‧慢性腎臟病與心臟血管疾病‧臨床醫學月刊，83（4），218-223。http://doi.org/10.6666/ClinMed.201904_83(4).0036

吳佩珍、陳欣毓、吳麗敏（2017）‧一位初期接受血液透析有自殺行為個案之護理經驗‧臺灣腎臟護理學會雜誌，16（3），42-55。http://doi.org/10.3966/172674042017091603004

吳紅蓮（2015）‧透析病人殘餘腎功能之重要性-控制飲食的鹽分及水分之應用‧腎臟與透析，27（2），98-102。http://doi.org/10.6340/KD.2015.27(2).12

吳紅蓮（2016）‧血液透析病人控制血鉀的重要性-飲食策略‧腎臟與透析，28（4），155-159。http://doi.org/10.6340/KD.2016.28(4).01

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