體液容積過量之原理背景及護理

The Theoretic Background and Nursing Care of Fluid Volume Excess

「體液容積過量」是臨床上常見的護理問題，不單只是與腎功能不全者相關，若未能早期發現，即時監測治療，將可能造成全身系統性的病變。然而何時該為病人立此護理診斷，卻常常困擾著護理人員，甚至儘管此護理問題已存在時，對它的界定仍然感到模糊，因而引發筆者撰寫本文的動機，欲藉由文獻查證的方式，針對「體液容積過量」之定義、鑑別診斷、原理背景及護理過程深入分析，除讓護理人員能更清楚地思考整個護理過程，也希望未來在照護此類病人的同時，能更正確而有自信地提供病人專業且高品質的護理。

“Fluid volume excess” is a common clinical nursing problem. Not only is it related to renal function impairment, it also affects overall systemic function if not monitored or treated in a timely manner. However, when should nursing diagnosis intervene? The question has always confused the clinic nurses. Although the diagnosis can be adopted, clear definition is lacking. Therefore, the purpose of this article is to explore the application of nursing diagnosis with focus on definition, differential diagnosis, theoretic background, and nursing process by literature review. The review article is intended to provide clinic nurses with the information to consider the nursing process and to provide professional and high quality care to patients with accuracy and confidence.