照顧一位腹膜透析併發橫膈疝氣的護理經驗

Nursing Experience of a Peritoneal Dialysis Patient Complicated by Diaphragmatic Hernia

本文旨在探討一位腹膜透析治療一個月的患者，併發橫膈疝氣的護理經驗，筆者在 2010 年 1 月 4 日至 3 月 31 日，運用羅式適應模式，藉由身體評估、觀察、會談、傾聽及查閱病歷等方式收集資料發現個案主要問題為低效性呼吸型態、術後疼痛、無望感。運用已建立的護病關係提供個別性護理措施，協助減緩其生理不適，採取放鬆技巧和靈性護理，加入宗教資源與家屬，改善個案因無望感與疾病所產生的衝擊，增加自我控制與參與感，獲得身、心、靈整合，重拾希望，回歸工作職場；持續的電訪與家訪追蹤，提升透析的自我照顧能力、自我肯定，成功恢復腹膜透析治療，達到最佳的調適及生活品質。希望藉此照顧經驗，提供臨床護理人員日後照護實務的參考。

This article examines the case of a patient that underwent peritoneal dialysis for one month complicated by diaphragmatic hernia. From January 4 to March 31, 2010, the author applied Roy’s Adaptation Model to collect the patient’s data through physical assessment, close observation, interview, listening and studying. The main nursing problems found were the inefficient breathing pattern, post-operative pain, and the feeling of hopelessness. Using the positive patient-nurse relationship established previously to provide personalized care, we alleviated the patient’s physical discomfort through relaxation techniques and spiritual care. Religious resources and family support was introduced to help the patient overcome the feeling of hopelessness and the effects of the disease. Strengthening self-control and sense of participation helped the patient come to terms with his physical and mental condition; regain hope and then return to work. Follow-up interviews and home visits enhanced the patient’s dialysis self-care ability and self-affirmation so peritoneal dialysis could be resumed. In this way, the patient was able to adapt and achieve the best quality of life. The nursing experience will hopefully provide a useful reference in future care activities by clinical nursing personnel.