照顧一位狼瘡性腎炎合併末期腎病變病人接受血液透析之護理經驗

本文探討一位狼瘡性腎炎合併末期腎病變病人面臨血液透析之護理經驗。護理期間2016年11月12日至12月9日，以觀察、會談、病歷查閱及Gordon十一項健康功能評估收集資料，發現個案有體液容積過量、抉擇衝突、無望感及潛在危險性感染等健康問題。個案職業為警察，平時需緝捕犯人，此次因肺水腫急需進行血液透析，當症狀緩解後因病人尚無法接受長期透析，經醫師評估暫時停止透析觀察，後因腎功能持續變差，體重上升，醫師告知病人需長期透析治療，在個案面臨透析模式抉擇衝突時，提供血液與腹膜透析影片及指導單張，安排跨團隊會議，讓病人、醫師、護理師及營養師共同討論，針對個案透析後可能面臨的問題，提供專業知識及協助，安排病友分享成功經驗，並在個案選擇血液透析後，以實物模型一對一指導管路換藥並完成回覆示教，返家前再次會診營養師提供居家飲食指導，協助個案為後續照護做最充分的準備。盼藉由協助病人選擇透析模式及疾病適應過程之經驗，做為護理人員臨床照護之參考。

關鍵字

狼瘡性腎炎；末期腎病變；血液透析

並列摘要

We investigate a nursing experience of taking care of a lupus nephritis patient with ESRD receiving first hemodialysis (HD). The nursing period was from November 12^(th), 2016 to December 9^(th), 2016. We collected information through observation, interview, chart review and Gordon 11 Functional Health Patterns. We found this patient with some health problems, e.g. fluid volume excess, conflict of choices, hopelessness, and potential risk of infection. This patient is a policeman. He received emergent HD due to pulmonary edema. After the symptoms and signs subsided, this patient did not accept long-term HD. Through the evaluation of physician, observation of HD terminated. Then due to renal function impairment and increased body weight, long-term HD was suggested. When this patient faced patterns of dialysis with conflict of choices, we provided this patient with the video of HD and peritoneal dialysis (PD) treatment and instruction sheet. Through multidisciplinary discussion, the patient, physicians, nurses, nutritionist got together to discuss about the possible problems after HD to provide professional knowledge and assistance. We also arranged the other patients to share their successful treatment experience. After this patient chose HD treatment, we taught this patient in person how to change dressing of tube through real model. Then this patient showed to us how to change dressing. Before this patient went home, we consulted nutritionist to provide diet instruction for this patient. We helped this patient well-prepared for further management. We hope the experience of helping the patient to choose treatment modality and deal with the disease could be shared by nursing staff in their clinical nursing.