照護一位糖尿病腎病變患者接受透析之護理經驗

The Experience of Caring for a Diabetes Nephropathy Patient with Hemodialysis

何慧菁(Hui-Chin Ho) ； 楊燦(Tsan Yang) ； 黃碧華(Pi-Hua Huang)

《台灣健康照顧研究學刊》 9期 (2010/08) Pp. 103+105-115

https://doi.org/10.29750/TJTHCA.201008.0008

摘要

本文探討一位糖尿病腎病變患者在醫師告知病況惡化後，拒絕治療以及再度到院時必須接受緊急透析治療的護理過程。筆者運用Gordon十一項功能性健康型態評估工具，經由身體評估、會談、觀察、病歷查閱等方式，收集主客觀資料，確立個案的健康問題有：「體液容積過量」、「特定性知識缺失－透析日常生活照護」、與「組織完整性受損」等。在照護期間筆者以個案為中心提供整體性照護，經由限水、依需求協助更換臥位及配合血液透析治療，以緩解肺水腫所引起的呼吸費力及不適；提供傷口護理及足部皮膚照護衛教指導，使個案急性期的生理症狀獲得緩解，此外，鼓勵個案表達內心的感受及想法，適時澄清其錯誤認知與訊息，以個案需求為導向，教導透析導管照護、飲食衛教訊息及透析日常生活照護，以增進個案及家屬對疾病的認知及照護能力，使其可平和的接受長期透析的事實，希冀此照護經驗能夠作為健康照護人員，於照護糖尿病腎病變患者之參考。

關鍵字

糖尿病腎病變 ； 糖尿病足病變 ； 透析患者衛教指導

並列摘要

The report explores the nursing process of hemodialysis treatment on the emergency case that a patient has diabetes and nephropathy eventually get complication causes by refusing to take the medical treatment after the doctor tell him that the condition is getting worse. The author used evaluating kits, includingGordon 11-item Functionality Healthy Patten Evaluation, physical assessment, interview, observation and chart review to collect the subjective and objective data and then make the conclusion that the case has several healthy issues, included: excess body fluid, lack of hemodialysis-related knowledge and lesion of tissues's completeness. During the care, the author provided the patient total-care. Through the limitation of fluid ingestion, assistance of changing position and accepted hemodialysis treatment to help patient to release the dyspnea caused by pulmonary edema. The author also provided the patient the wound care and foot-care hygiene education to reduce physical symptom during acute stage.In addition, encouraged the patient to expresses true feelings and opinions, timely clarify incorrected perspective and information and taught him the care about dialysis catheter, information about dietary education and daily care of dialysis treatments, to help patient and family to improve on the knowledge about the disease and ability of care, and then made them to accept the truth that the patient need to take a long-term dialysis treatment. Hopefully, through sharing the experience can provide nursing staff as a reference when you are taking care of the similar patients in the future.

並列關鍵字

diabetes nephropathy ； foot problem with diabetic mellitus ； hygiene education of dialysis patient