照護一位血液透析患者合併腦中風之護理經驗

A Clinical Challenge in Caring for a Hemodialysis Patient with Stroke

洪子惠(Tzu-Hui Hung) ； 曾雅婷(Ya-Ting Tseng)

《志為護理-慈濟護理雜誌》 13卷3期 (2014/06) Pp. 107-117

摘要

本文描述一位慢性腎病需長期血液透析及併發腦中風個案之護理經驗。個案有糖尿病、高血壓病史二十年，此次因腦中風導致左側肢體偏癱，造成身心調適衝擊。故筆者於2012年4月9日至2012年7月2日，透過身體評估、會談、觀察、傾聽及實際照護方式收集資料，歸納個案的健康問題包括：體液容積過量、身體活動功能障礙、無力感等，針對體液容積過量，給予緊急透析治療與飲食攝取量的記錄執行來改善呼吸喘問題；面對身體活動功能障礙，與復健科同仁一起擬訂復健計劃來增加自我照顧能力；對於無力感的問題，協同院牧部及同儕利用全人關懷手法，給予支持與鼓勵，並與個案、家屬建立良好的護病關係，鼓勵個案表達內心的感受等關懷活動。經由一連串的護理措施介入，使得個案可以以正向的態度面對疾病所帶來的衝擊，同時也能積極接受復健，用樂觀及積極的心態面對長期復健活動，增進個案的自我照顧能力，進而提升其生活品質。

關鍵字

尿毒症 ； 血液透析 ； 腦中風 ； 無力感

並列摘要

The article described the nursing experience of a chronic kidney disease patient, complicated with stroke, who required long-term hemodialysis. The patient had a 20-year history of diabetes and high blood pressure, and the recent stroke left him with a left hemiplegia, which resulted in physical and mental adaptation shock. During the nursing period from April 9, 2012 to July 2, 2012, three major health issues were identified: 1) fluid overload; 2) impaired physical mobility; and 3) powerlessness. Regarding fluid overload, we initiated execution recording of emergency dialysis treatment and dietary intake to address the dyspnea; as for impaired physical mobility, we drafted a rehabilitation plan with colleagues of rehabilitation department to enhance self-care skills. On the issue of powerlessness, we provided support and encourage with holistic care approach by collaborating with colleagues and chaplaincy department, and established a positive relationship with patients and families while encouraging the patient to express inner feelings. Through a series of nursing interventions, the patient could adopt a positive mentality towards the impact of the disease and long-term rehabilitation, which would enhance the patient's self-care ability and further improve the life quality.

並列關鍵字

uremia ； hemodialysis ； stroke ； powerlessness