一位狼瘡性腎炎患者接受腹膜透析之護理經驗

The Nursing Experience of Assisting a Lupus Erythematosus Patient Diagnosed with Peritoneal Dialysis

本文主要是探討一位狼瘡性腎炎個案併發末期腎衰竭在首次選擇透析治療模式的護理經驗。護理期間自2011 年7 月15 日至10 月15 日，筆者以Gordon十一項健康功能型態作為評估工具並利用觀察、會談、身體評估收集資料，發現個案有抉擇衝突、潛在性感染及營養少於身體所需等健康問題。筆者於護理期間與個案建立信任的關係，主動提供透析治療的相關資訊，增加個案對透析治療之具體認識，減輕抉擇衝突困擾。個案接受腹部植入透析管手術後，筆者對其照護重點是指導個案傷口照護及腹膜透析技能避免感染發生，再協同營養師依個案飲食需求，提供飲食指導並共同與個案設計適宜的飲食型態以協助個案能攝取均衡飲食。個案能經由護理指導選擇合宜的透析模式、遵從正確居家自我照顧技能及攝取足夠的營養需求。This case report describes the experience of providing nursing care to a 32-year-old man during his decision-making process in selecting a type of dialysis treatment. Care was provided from July 15 to October 15, 2011. The Gordon 11-item Functional Health Pattern was used to assess the patient's health problems, and relevant data were collected by conducting physical examinations, observations, and interviews. We found that the patient was experiencing decisional conflict, at risk for infection and nutrition less than body requirement. We recommend that the nursing care process involve providing information, sharing experiences, and introducing the hemodialysis process to mitigate the decisional conflicts experienced by the patient and to provide support for the patient to face future dialysis treatment, such as building relationships of trust in the nursing process to teach self-care skills, to increase confidence in the treatment, and to prevent infection risk for peritonitis. Nurses should collaborate with dieticians to develop dietary instructions for the patient based on his dietary requirements, and work with the patient in designing a suitable dietary model for him. Nurses should also assist the patient with selecting the type of dialysis treatment suitable, teach him home self-care skills, and assist him with maintaining an appropriate diet. By employing these strategies, nurses could provide the support that the patient required to improve his quality of life. The results of this report can serve as a reference for nursing staff, and may assist nurses with providing care for similar patients in the future.