照護一位初次接受血液透析病患之護理經驗

Nursing for a Recently Diagnosed Hemodialysis Patient

本文旨在描述一位70歲老人，健檢時發現體重突然增加4 公斤且抽血值中尿素氮及肌酸酐值高，腳踝水腫2+，開始接受初次透析之護理經驗，以Gordon十一項健康功能型態為評估架構，利用溝通、觀察、會談等方法收集資料，護理期間為95年7月10日至95年7月16日，結果發現個案有:體液容積過量、焦慮、特定知識缺失等護理問題。經由與個案討論說明提供水份控制衛教，減少透析中不適症狀發生，並指導減少口乾不適的症狀進而降低水份攝取及口渴，維持皮膚完整性，參觀透析過程及教導如何減輕壓力與放鬆技巧等有效護理措施介入後，結果有效將體重控制於不超過乾體重80.5±3.0 Kg範圍之內，使個案腳踝無水腫情形至且感覺口渴時可控制水分攝取約600-800 cc/天，維持皮膚完整、每日做握球運動以防止瘻管阻塞並促進血液循環，同時不再害怕管子阻塞並至洗腎室參觀他人透析過程；學會如何控制飲食避免病情再惡化，提供成功洗腎案例，能以健康的態度，走入人群，積極參與社交活動，促使個案能面對未來長期透析生活。

This paper addresses the nursing experience of an 70-year-old patient who was discovered to have an increase in weight by three kilograms during a health checkup and was also diagnosed with a high level of blood urea, nitrogen and serum creatinine value. Gordon's 11 functions of health were adopted to evaluate and assess nursing for the patient's first dialysis and communication, observation, and interviews were used to collect data. The nursing period started from July 10 to July 16, 2006. The results showed three nursing problems. The first was that due to an insufficient knowledge of the intake limitation of water and salt for uremia, the subject had increased body weight. Next, because of a poor understanding of caring for arteriovenous fistula and fistula embolism, the subject felt anxious. Lastly, the subject was unprepared for dialysis since it was the first one. The subject was unfamiliar with the dialysis process, notes for attention, and diet management. Through instruction and discussion, the subject learned about the causes and symptoms of uremia and the control method for daily water intake. Moreover, the subject learned hand grasp exercises and techniques to reduce stress. The subject also received relevant information about effective nursing intervention such as the knowledge, process, points for attention, and diet plan involved in dialysis treatment. Consequently, the subject was able to maintain a water intake of daily urine plus 600-800cc, evaluate and assess the function of arteriovenous fistula by himself, and use hand grasp exercises to prevent fistula embolism and promote smooth blood circulation. He would not worry about his circulation during dialysis and was able to walk independently. The subject learned the main points of his treatment and managed his diet to avoid increasing the symptoms. The nursing process satisfied the physical and psychological needs of the subject and gave mental support and encouragement to help the subject face life of dialysis treatment.