運用Orem理論於一位初接受腹膜透析病患之護理經驗

he Application of Orem's Theory in Caring a Fresh ESRD Patient with Peritoneal Dialysis Treatment

末期腎衰竭除了接受腎臟移植，目前替代治療只有血液透析與腹膜透析。腹膜透析為居家透析治療，病患須承擔自我照顧重大責任，因此提昇病患自我照顧能力是主要護理職責。本文應用Orem理論，護理一位初接受腹膜透析治療之個案，經評估確立其有組織完整性受損、知識缺失、潛在危險性感染、潛在性體液容積過量之護理問題，而給予部份代償性、支持與衛教性護理措施，協助個案修正生活習慣，學習建立自我照顧能力。訓練過程中病患本身之自我照顧意願是最大影響因素，能夠面對疾病，有意願改變，確實遵照治療，將治療整合到日常生活中，才能克服健康偏差的影響，改善生活品質。末期腎衰竭是慢性、長期性、即使經過治療仍無法痊癒之疾病，病患要面對的不只是腎臟單一問題，而是全身性、心理與社會各方面難題，因此護理上需持續不斷評估、介入與評值才能預防及減少併發症產生。

Besides renal transplantation, hemodialysis and peritoneal dialysis are the only replacement therapies available to treatment patients with end stage renal failure. Because some patients can self-administer peritoneal dialysis in the home, promoting the self-care of patients is a primary nursing duty. This article applies Orem’s theory with a new dialysis patient. The nursing diagnosis found impaired tissue integrity, knowledge deficits, risk for infection, and risk for fluid volume excess. Based on the nursing diagnosis, the patient was provided with supportive health education. The results show that the key points for promoting good outcomes are that the patient has effective self-care behaviors and a positive attitude towards the disease. End stage renal failure not only includes physical impairments, but also affects the patient psychologically and socially, so continued assessments, intervention, and evaluation can realize prevention and avoidance of side effects.