一位末期腎病患者面臨透析治療抉擇之護理經驗

Nursing Experience of Assisting a Patient with Terminal Stage Renal Disease Making Decision about Dialysis Therapy

連續性活動性腹膜透析(continuous ambulatory peritoneal dialysis, CAPD)為末期腎病患者選擇的治療方式之一，本文的護理對象為一個利用連續性活動性腹膜透析治療末期腎病患者面臨生理和心理的不適，自2004年5月3日至5月21日的護理過程中，經由觀察、會談的方式收集資料，依Gordon功能性健康型態確立個案主要護理問題為抉擇衝突、危險性感染與健康尋求行為三項問題。筆者針對個案問題的所在，協助指導個案了解血液透析與連續性活動性腹膜透析治療差異，使個案得以接受適合的治療方式，利用討論、諮商、回覆示教等方式循序漸進，讓個案在醫護團隊的協助下、成功的學習如何自我照護及了解預防感染的重要性，達到持續性的護理，讓個案可回歸正常的生活型態，且提升返家後的自我照顧能力。期望藉此護理經驗，讓臨床同仁在照顧此類患者時，能提供更適切的護理，以同時解決患者身心各方面之困擾。

Continuous ambulatory peritoneal dialysis (CAPD) is one of the therapy options for a patient with renal disease at the terminal stage. This case report described the nursing experience of a patient with renal disease who suffered uncomfortable physical and psychological symptoms due to CAPD therapy. Data were collected by observation and interviewing during the nursing period from the 3rd to the 21st of May in 2004. According to Gordon’s functional health types, there were three main nursing problems involved in this case, including decisional conflict (decision making conflicts), dangerous infection and health-seeking behaviors. The researcher had patiently assisted the patient accepting the proper treatment by instructing the patient to distinguish the treatment difference between hemodialysis and CAPD. After discussion, consultation, and repeated demonstration, the patient had successfully learned about the methods of self-care and understood the importance of preventing infections. With continuous nursing treatment, the patient was able to return to a normal life style with improved self-care ability. The report provides nursing staff with experience of caring similar patient in the future.