一位末期腎病青年初次血液透析之護理經驗

Nursing Care for a Young Person with End Stage Renal Disease Receiving Hemodialysis

王沐昕(Mu-Hsin Wang) ； 謝春滿(Chun-Man Hsieh)

《長期照護雜誌》 14卷2期 (2010/09) Pp. 223-235

https://doi.org/10.6317/LTC.201009_14(2).0009

摘要

本文旨在探討一位末期腎病青年初次接受長期血液透析之照護經驗。護理期間（2008年11月10日至2009年1月10日）藉由觀察、會談、查閱病歷及電訪，以羅氏適應模式作為評估工具，收集個案健康相關資料，歸納主要護理問題有：體液容積過量、身體心像紊亂、無效性因應能力等。過程運用專業知識，設計血壓、體重自我監控評估表，配合行為修正解決透析間體液容積過量問題。心理社會問題則提供個別、持續性護理，設定目標並傾聽、主動關懷個案需求，協助正向面對身體改變之事實；鼓勵表達內心感受，建構出新的自我價值，以適應透析後生活，同時協助個案與腎友、外界團體接觸，互相支持與意見交流，進而重建個案自信與回歸社會，促使面對初次長期透析時能正向調適。期望將此護理經驗供護理人員分享，作為日後照顧此類病患之參考。

關鍵字

血液透析 ； 體液容積過量 ； 身體心像紊亂 ； 適應

並列摘要

The purpose of this article was to describe a nursing care of a 30-year-old young person, with end stage renal disease (ESRD) due to chronic renal failure and the patient’s personal journey when facing long term dialysis for the first time. During the provision of nursing care (from November 10 in 2008 to January 10 in 2009), the author, through observation, conversation, active listening, medical chart review and telephone calls, had gathered objective and subjective information regarding the patient's physiology, mental health status, social situation and spirituality. Roy's model as was applied as an assessment framework to analyze and categorize the main nursing issues, which includes excess fluid volume, disturbed body image and ineffective adaptive ability. Nursing care involved the employment of professional knowledge, design of self-monitoring evaluation of the blood pressure and weight and behavioral modification for resolving issues related to excess fluid volume during dialysis.
In light of psychological and social issues, the author suggests providing individual and persistent nursing care, setting goals, actively listen to and care for the patient’s needs, facilitating positive attitude towards the reality of bodily changes; at the same time encourage emotional expression and the construction of new self-values to adapt lifestyle post dialysis. The author can be the communication bridge between the patient and the other patients on dialysis as well as the relevant organizations. They can support each other and exchange opinions to rebuild the patient's confidence in returning to the community and promote positive physiological and psychological adaptation to the initial experience of hemodialysis. The author hopes to share this particular experience, which can be a reference for providing nursing care to the similar type of patients, with the other nursing staff.

並列關鍵字

hemodialysis ； excess fluid volume ； disturbed body image ； adaptation/adjustment