一位末期腎病病人初次接受腹膜透析之護理經驗

A Nursing Experience for a Patient Receiving Peritoneal Dialysis

本文探討一位68歲男性，因罹患糖尿病導致慢性腎衰竭接受腹膜透析治療之護理經驗。護理期間自2008年07月23日至2008年08月15日，根據個案出現的臨床症狀以觀察、溝通及會談等方式收集資料，運用Gordon十一項健康功能評估收集資料，歸納個案主要護理問題，包括：保護能力改變、知識缺失以及無望感。藉由腹脹透析的教學光碟及特殊教具，以一對一的教學方式教導以無菌步驟更換透析液，並使用實物模型示範導管出口處護理，增加個案對腹膜透析治療的相關知識，以及居家自我照顧注意事項，讓個案能正確且完整的操作腹膜透析居家自我照顧技術；並鼓勵個案正視腹膜透析導管，接受腹膜透析治療，再經由腎友經驗分享和家人支持，最終能讓個案維持正向的態度。經過照護此個案之護理經驗，讓護理人員利用專業獨立且具個別性的護理措施幫助個案解決身心問題的照護活動，以提供照護慢性腎病執行腹脹透析護理之參考。

This article investigates a 68-year-old male receiving peritoneal dialysis due to chronic renal failure secondary to diabetes mellitus. The period of nursing care was from July 23 to August 15, 2008. Data were collected based on patient observation of signs and symptoms, communication, and interview. The author used Gordon's Functional Health Pattern for patient assessment and identified the nursing problems to include an alteration of protection, a lack of knowledge, and a feeling of hopelessness. The teaching method was one-on-one with the use of a DVD and relevant teaching tools. The patient was taught the procedure of peritoneal dialysis exchange in the aseptic technique. A return demonstration was performed for the dialysis exit care to enhance the patient's knowledge associated with peritoneal dialysis and self-care. The patient was encouraged to view the peritoneal dialysis catheter and accept the treatment of peritoneal dialysis. By sharing this experience with other dialysis patients and family support, the patient could face the treatment with a positive attitude. Nursing professionals may assist in solving the patient's care problems in physical and psychological aspects via nursing expertise in peritoneal dialysis. This article may be used as reference for patients with chronic renal disease receiving peritoneal dialysis.