照護一位末期腎病變病人初次接受血液透析之護理經驗

A Nursing Care Experience for an End-Stage Renal Disease Patient Undergoing Initial Hemodialysis

蔡豐光(Feng-Guang Tsai) ； 謝佩穎(Pei-Yin Hsieh) ； 蔡慧玲(Hui-Ling Tsai)

《臺大護理雜誌》 15卷1期 (2019/01) Pp. 76-87

https://doi.org/10.6740/NTUHJN.201901_15(1).0008

摘要

本文為照護一位末期腎病變的中年女性面臨腎功能衰竭，初次血液透析所引發生理、心理及社會問題之護理經驗。於2017年2月4日至2月21日照護期間，藉由主動關懷、觀察、會談、身體檢查及Gordon 11項功能性健康型態評估收集資料，整體性評估後發現個案於住院期間出現呼吸喘、水腫、活動力下降、胃口降低、睡眠障礙、疲憊等狀況，確立個案有體液容積過量、特定知識缺失及焦慮之健康問題，尋求文獻佐證於照護過程中，依照其需求提供個別性護理措施，提供血液透析相關知識，照會營養師與個案利用飲食日誌共同討論食物代換及相關飲食指導；同理個案初次面臨透析之不安情緒，透過陪伴、家屬支持及腎臟病友經驗分享，引導個案適當的表達情緒及想法，使其身、心及社會層面都獲得改善，並以正向的態度面對透析治療及後續生活，提升自我照顧能力，適應長期血液透析治療。建議照顧初次血液透析病人時，以主動關懷、傾聽、同理心為出發點，給予病人和家屬心理支持及鼓勵，再以跨團隊合作照護解決病人生心理方面之問題，陪伴病人度過初次血液透析衝擊的過程。冀望藉由此病人報告，提供臨床護理人員照護初次血液透析病人之參考。

關鍵字

末期腎病變 ； 初次血液透析 ； 焦慮

並列摘要

This article described a nursing experience of a middle-aged woman with end-stage renal disease to start hemodialysis due to renal failure and some physiological, psychological, and social problems caused by initial hemodialysis. Nursing period was from February 4^(th) to 21^(st), 2017. Gordon's 11-item functional health assessment were used to collect data through direct care observation, interview, and physical examination. Integrated holistic assessment found that patient had tachypnea, edema, activity decreased, poor appetite, insomnia, and fatigue. The identified major health problems included fluid volume excess, knowledge deficiency, and anxiety. The individualized nursing education intervention was applied in the nursing care process. We assisted the patient with educational content about renal diet via nutritionist cooperation and discussion. Through companionship, support from family members and sharing experiences with dialysis patients, encourage the patient to express his emotions and opinions. The patient was upgraded self-care ability and positive attitude to face long-term dialysis treatment and further life. We suggest the following nursing interventions to care of the first time hemodialysis patients: listen, give empathy to patients and their families support and encouragement, and then through inter-professional team work to solve problems. This nursing experience provided a wonderful reference should help nursing staff taking care of patient undergoing initial hemodialysis.

並列關鍵字

end-stage renal disease ； initial hemodialysis ； anxiety