一位急性腎衰竭病人施行連續性腎臟替代療法之護理經驗

Nursing care Experience of a Patient with Acute Renal Failure Who Underwent the Continuous Renal Replacement Therapy

莊蕙霞(Hui-Hsia Chuang) ； 賴美玉(Mei-Yu Lai)

《若瑟醫護雜誌》 8卷1期 (2014/08) Pp. 76-87

摘要

本文探討一位因急性腎衰竭接受連續性腎臟代替療法之護理經驗，護理期間自2012年1月10日至1月18日，藉由直接照護、觀察、筆談、身體評估及病歷查閱收集資料，運用Gordon十一項功能性健康型態評估，確立個案主要護理問題有：體液容積過量、高危險性感染、焦慮。於照護過程中，改善個案呼吸困難症狀、維持呼吸道通暢及適量的氧合，每班監測血液動力學、維持電解質及體液輸出入量平衡，給予水腫皮膚的照護，於病情恢復後衛教水分的控制。在急性期加強侵入性導管置入部位傷口的護理，保持傷口清潔乾燥、觀察傷口分泌物，並運用傾聽溝通技巧與個案建立信任感，鼓勵家屬陪伴及透過宗教信仰的寄託轉移注意力，以減輕不安情緒、放鬆心情使個案回歸正常生活。

關鍵字

急性腎衰竭 ； 連續性腎臟替代療法 ； 護理

並列摘要

This case study describes the nursing care experience of a patient with acute renal failure who underwent the continuous renal replacement therapy. The duration of nursing care was between January 10th, 2012 and January 18(superscript), 2012. The author collected data by direct care, observation, physical assessment, personal interviews, medical record and the care was guided by Gordon's 11 functional health status method in order to identify the patient's major health problems. Based on the Gorden's functional health assessment, the case's health problems included 1. volume overload. 2. potential risks of infection. 3. anxiety. During the nursing care period, the author provided clinical care to improve dyspnea condition, maintain the airway and oxygenation, close monitoring of vital signs, maintain Electrolyte and fluid homeostasis, maintain the patient's skin integrity by means of skin care and provide patient education to understand fluid control. In the acute phase, the author provided the rigorous catheter care to maintain the wound clear and used the listening and communication skills to establish a sense of trust. In addition, we have encouraged family members to accompany and provided religion sustenance, in order to relax and reduce anxiety. Finally, we reduce the CRRT therapy complications and make the patient return to normal life.

並列關鍵字

Acute renal failure ； Continuous renal replacement therapy ； Nursing