一位熱傷害致橫紋肌溶解症倂急性腎損傷病人之護理經驗

A Nursing Experience in a Patient with Rhabdomyolysis and Acute Kidney Injury Caused by Thermal Injury

施倩鈴(Chien-Ling Shih) ； 王育鵑(Yu-Jyuan Wang)

《高雄護理雜誌》 37卷3期 (2020/12) Pp. 133-145

https://doi.org/10.6692/KJN.202012_37(3).0012

摘要

本文是一軍人因熱傷害併急性橫紋肌溶解症及急性腎損傷之護理經驗，照護期間為2016/5/9至2016/5/19，藉觀察、會談、照護等方式收集資料，進行生理、心理、社會、靈性等層面評估，確立護理問題有：組織灌流失效：腎臟、體溫過高、個人因應能力失調。藉降溫、監測輸出入量、靜脈輸液、使用藥物及血液透析等，個案腎臟能達到充足灌流，體溫及腎功能能回復正常；因應壓力方面，除讓個案正視壓力及其對自身的影響，鼓勵個案表達感受、提問、尋求協助、正向思考，並說明治療的過程與必要性，指導個案面對疾病與治療的壓力時，能使用轉移注意力、娛樂活動、尋找社會支持、有計畫地解決問題等更正向的因應方式。

關鍵字

橫紋肌溶解症 ； 腎臟組織灌流失效 ； 體溫過高 ； 因應能力

並列摘要

This article concerns a nursing experience in a patient with rhabdomyolysis and acute kidney injury caused by thermal injury. During the period of care from 2016/5/9 to 2016/5/19, the author collected data from observation and interviews, then assessed the physiological, psychological, spiritual and social aspects of this case, and a nursing diagnosis was established as altered tissue perfusion: renal and hyperthermic; and ineffective individual coping. We conducted strategies to manage renal dysfunction and hyperthermia, such as cooling down the body temperature, monitoring the intake and output, giving fluid resuscitation and medication, and providing intermittent hemodialysis. In response to ineffective coping, we explained the process and necessity of treatment to the patient. We also let him understand the stress caused by treatment and its serious impact on himself. He was encouraged to express concerns, ask questions, seek assistance, and develop positive thinking, and was then guided to use more positive and effective coping strategies such as diverting attention, engaging in entertainment, and understanding the stress of the disease and treatment as well.

並列關鍵字

rhabdomyolysis ； altered renal tissue perfusion ； hyperthermia ； coping ability

參考文獻

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