一位末期腎病變老年病人初次血液透析之護理經驗

The Nursing Care of a Elderly Patient with End Stage Renal Disease Requiring Hemodialysis

許壽惠(Shou-Hui Hsu) ； 高美華(Mei-Hua Kao)

《馬偕護理雜誌》 9卷1期 (2015/01) Pp. 88-98

https://doi.org/10.29415/JMKN.201501_9(1).0008

摘要

本文敘述一位糖尿病合併末期腎病變之老年病人初次接受血液透析治療之護理經驗。門診護理期間為2013年6月10日至2013年6月30日，以Gordon十一項健康功能型態為評估架構，運用會談、觀察、查閱病歷與身體評估等方式收集資料，歸納個案之護理問題包括：特定的知識缺失、腹瀉、高危險性傷害／跌倒與焦慮。在護理過程中，給予血液透析資訊及指導瘻管照顧方法；提供飲食護理指導，減少腸胃道不適；讓個案了解預防跌倒減輕傷害的重要性及相關措施，鼓勵個案表達對血液透析的感受及給予心理支持。護理措施介入後，個案能正確執行瘻管照顧，腹瀉情況改善，日常生活沒有跌倒發生，焦慮感減輕，並表達持續健康照顧的意願。護理過程之經驗提供臨床護理人員照護老年病人接受血液透析之運用，增進個案自我照護能力與生活品質。

關鍵字

血液透析 ； 末期腎病變 ； 護理

並列摘要

This case study was to describe the nursing care for a elderly diabetic patient with end stage renal disease requiring hemodialysis for the first time. Nursing care period was from June 10 to June 30, 2013. The data were collected by interviewing, observation, chart review and physical assessment. The Gordon's Functional Health Patterns was applied to assess, evaluate and identify the nursing problems of the patient. The major nursing problems included specific knowledge deficit, diarrhea, risk for injury (fall) and anxiety. In the process of the nursing care, the nurse provided information regarding hemodialysis, care of fistula , dietary guidance for reducing gastrointestinal discomfort, preventions of falls and the importance of harm-reduction measures, and encouraged the patient to express his/her feelings including perceptions regarding receiving hemodialysis and offered psychological support when needed. After the nursing interventions, the patient was able to carry out correctly the fistula care his/herself, and the problem of diarrhea improved. Moreover, the patient showed no record of fall during the studied period, demonstrated reduced anxiety level and expressed wishes to receiving continuous care. This nursing care may provide evidence for other nurses when caring for eldery patients receiving hemodialysis in clinical practice, and ways to enhance the patients' self-care ability and their quality of life.

並列關鍵字

hemodialysis ； end stage renal disease ； nursing care