一位末期腎病患者撤除血液透析治療的護理經驗

Nursing Experience about the Withdrawal of Hemodialysis in Patient with End Stage Renal Disease

張曉琪(Hsiao-Chi Chang) ； 鄭莉縈(Li-Ying Cheng) ； 鄭如芬(Ju-Fen Cheng)

《彰化護理》 26卷1期 (2019/03) Pp. 97-107

https://doi.org/10.6647/CN.201903_26(1).0012

摘要

本文旨在敘述一位末期腎病長期接受血液透析因感染導致敗血症面臨生命末期的生理、心理衝擊及心靈困擾之護理過程。筆者於2015年10月14日至2015年11月01日照護期間，運用五大層面護理評估為架構，藉由溝通、身體評估及病歷查閱等方式收集及分析主客觀資料，確立個案健康問題有呼吸道清除功能失效、體液容積過量、身體活動功能障礙、無望感及死亡焦慮。因傳統道德文化的束縛，患者及家屬害怕談論死亡而使患者即便已達生命末期，仍積極接受極盡的醫療而得不到善終，筆者運用安寧療護的症狀緩解治療、跨團隊醫療計畫及安排家庭會議，營造全人、全程、全家及全隊照護，提供個別性和即時性的護理措施，安排宗教團體支持，經由以上護理措施，不僅讓個案願意參與醫療決策及完成簽屬不施行心肺復甦術意願書，並幫助個案平順完成四道人生也完成協助個案身、心、靈安適面對臨終過程，達到善終。期望藉由本文護理經驗分享，在照護預期於6個月內將死亡或預後不佳的患者，及早提供安寧療護選擇，並提供臨床末期患者照護之照護參考依據。

關鍵字

末期腎病 ； 撤除 ； 血液透析

並列摘要

This article describes the experience of caring a patient with end-stage renal disease who received hemodialysis complicated with sepsis and resulted in physical, psychological, and spiritual disturbance. The nursing period was from October 14 to November 1, 2015. Five facets of psychiatry assessment was applied. Data were collected based on communication, physical assessment, and medical record reviewing. The main health problems were as followings: ineffective airway clearance, body fluid overload, functional impairment of physical mobility, hopelessness, and death-related anxiety. Because of traditional culture bound, patient and family were afraid of talking about death when facing dying process. Instead, they tried aggressive treatment. But this could not give patient good end. Author applied hospice care to relieve symptom and multidisciplinary team discussion to make medical planning. With holistic care concept, individualized nursing intervention and religious group support were provided. Author helped the patient to take part in medical decision and signed Do Not Resuscitate Consent. Furthermore, patient could expressed his apology, thanks, love, and goodbye to his family by guidance and come to good end. This case report provides reference experiences that should help nursing personnel to make hospice care a choice for patient in the end-of-life.

並列關鍵字

end stage renal disease ； withdrawal ； hemodialysis

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