一位血液透析病人不遵從透析醫囑之護理經驗

Nursing Experience in Caring for a Hemodialysis Patient with Medical Noncompliance

蔡美玲(Mei-Ling Tsai) ； 戴培惠(Pei-Hui Tai)

《若瑟醫護雜誌》 15卷1期 (2021/07) Pp. 70-82

摘要

本文是探討一位血液透析病人不遵從透析醫囑之護理經驗。護理期間自2017年3月6日至2017年5月8日，經由臨床照護、會談、傾聽、觀察、身體評估及電子病歷查閱等方式收集資料，運用Gordon十一項健康功能整體性評估，確立健康問題有不遵從、體液容積過量、潛在危險性感染等護理問題，藉由個別性的指導以及護理衛教QR cord連結提供適當的護理措施，加強水分控制的技巧，使兩次透析間體重由原本重達5~7公斤控制在5公斤以內；個案對於導管留置以及動靜脈瘻管的照護，可藉由良好衛生習慣以及導管照護前後洗手以預防感染；運用傾聽、溝通技巧及鼓勵個案表達內心感受，引導個案能正向面對血液透析緩和內心的抗拒，使個案能遵從透析醫療行為。

關鍵字

血液透析 ； 體液容積過量 ； 不遵從

並列摘要

This paper discusses a nursing experience in caring for a hemodialysis patient with medical noncompliance. The nursing period spanned from March 6, 2017 to May 8, 2017, during which data were collected through clinical care, interviews, listening, observation, physical evaluations, and the patient's electronic health record. Gordon's functional health patterns assessment was adopted to confirm several nursing and health problems, medical noncompliance, including fluid overload, and potentially hazardous infections. Appropriate nursing measures were administered through the application of individualized guidance and health education together with quick response codes. Fluid control was improved to reduce the weight gain between two dialysis sessions from 5-7 kg to ＜5 kg. Regarding the management of catheterization and arteriovenous fistulas, favorable hygiene practice and hand wash before and after fistula adjustment should be conducted to prevent infections. Listening and communication skills should be adopted to encourage the patient to express his thoughts, helping the patient develop a positive attitude, overcome his resistance to hemodialysis, and comply with the doctor's instructions.

並列關鍵字

hemodialysis ； fluid overflow ； noncompliance

參考文獻

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