一位腹膜透析併發腹膜炎青少年之護理經驗

The Nursing Experience of a Teenager with Peritonitis Induced by Peritoneal Dialysis

本篇報告描述一位16歲青少年期的女性，因罹患紅斑性狼瘡導致末期腎病，在家行腹膜透析發生腹膜炎而入院治療之護理經驗。筆者於2008年1月22日至1月30日照顧個案期間，運用歐倫自我照顧理論模式，評估個案自我照顧能力，並藉由觀察、傾聽、會談及檢視病歷紀錄，確立其健康問題為：體液容積過多／與感染腹膜炎，白蛋白流失至透析液有關、身體心像紊亂／與裝置腹膜透析管路有關、知識缺失／缺乏腹膜透析相關知識。在整個護理過程中，筆者運用主動關懷及同理個案的感受，並藉由完全性代償、部分性代償及支持性教育護理的介入，提供適當的護理措施及護理指導，改善個案體液容積過多的問題，引發個案學習動機並對腹膜透析有正向、正確的觀念，並協助個案適應身體心像的改變並且學習正確腹膜透析的知識，進而達成自我照顧。期望藉由此篇個案報告將其護理經驗與護理同仁分享，提供日後護理此類患者之參考。

We would like to report the nursing experience of a 16-year-old girl with peritonitis caused by peritoneal dialysis, which she received at home for systemic lupus erythematosus-induced end stage renal disease. The girl was hospitalized at our ward from January 22nd to 31st, 2008. The author applied Orem’s Self-Care Nursing Theory to evaluate the patient’s self care capability via observation, attentive listening, interviews, and inspection of patient’s medical records/charts. The authors confirmed that her health problems were excess fluid retention, psychosomatic disorientation due to insertion of hemodialysis catheterization tubes, and knowledge deficit. During the hospitalization period, the author used active caring and empathy approach and implemented total compensation, partial compensation, and supportive education nursing intervention. We provided patient with adequate medical equipment and nursing instructions to improve her water retention problem. We also provided patient with the incentive to learn about peritoneal dialysis and how to face this daily task in a positive perspective. We helped the patient adapt her body image changes so that she could accomplish peritoneal dialysis self care at home. We hope to share our valuable experiences with other nursing staff.