運用歐倫理論協助一位腹膜透析失敗轉血液透析的護理經驗

Nursing experience of applying Orem’s Theory to help a peritoneal dialysis patient cope with hemodialysis

本文是探討一位 50 歲男性病患因接受腹膜透析後引發腹膜炎，暫轉血液透析治療的護理經驗。個案用心照護自己，卻仍發生腹膜感染，加上治療過程，對身體造成極大的不適，讓個案決定不再接受腹膜透析轉以血液透析治療為替代療法，但兩者的照護模式是截然不同的，對生活上的改變與衝擊，是個案始料未及的。筆者於 2010年 1 月 3 日至 2010 年 3 月 25 日照護期間利用歐倫理論評估後，確立個案有體液容積過量、知識缺失及焦慮等護理問題。筆者藉由衛教相關教材、轉介營養師及適時的在旁輔助說明，使個案了解體液容積過量與水份控制的重要性，釐清個案對血液透析照護之疑慮，減輕個案的焦慮感，提升個案自我照顧能力，並能積極正向的面對透析生活。

This article describes the nursing experience of caring for a fifty-year-old male patient who had to be temporarily converted to hemodialysis after failed peritoneal dialysis led to peritonitis. The patient tried hard to take care of himself but peritonitis still occurred. As the treatment caused great discomfort, the patient decided to convert over to hemodialysis instead. The very different care models as well as the impact and changes to lifestyle came as a shock to the patient however. During the care period between January 3 and March 25, 2010, an evaluation using Orem’s Theory was conducted by the author and confirmed the following problems: excess fluid volume, deficient knowledge and anxiety. Through health education materials, dietician referral and explanations when appropriate, the patient was educated about the importance of fluid volume excess and fluid control, doubts on hemodialysis care clarified, anxiety eased, self-care ability improved and ultimately prepared to approach life with dialysis in a positive manner.