照護一位糖尿病腎病變病患初次血液透析之護理經驗

The Experience of Nursing a Patient with Diabetic Nephropathy Who Is Undergoing Hemodialysis for the First Time

本篇報告主要是在探討糖尿病腎病變個案初次接受血液透析治療過程中所遭遇的身、心、社會的問題，尤其是針對糖尿病飲食的規劃及自我照顧能力的提昇，筆者運用衛教指導、營養諮詢、支持與提供資源等護理措施，協助個案適應疾病及住院所帶來的壓力與危機，使個案成功調適初次接受血液透析治療所帶來的衝擊。筆者以Gordon十一項健康功能型態進行護理評估，運用觀察、會談技巧收集資料，確立個案有潛在危險性感染、舒適情況改變－－皮膚搔癢症、知識缺失－－糖尿病、腎衰竭與血液透析復日常生活照護、營養改變－－少於身體所需等護理問題，提供相關護理措施，並於個案出院後透過電訪及返診會談，評值衛教指導的成效，以了解新接受血液透析個案在出院後所遭遇的困難，給予持續性的護理服務，增加個案的安全感及信心，增強參與健康促進活動的意願及因應透析後生活型態的改變。

This report is mainly meant to explore what the physical, psychological and social problems the patient encountered while receiving hemodialysis for the first time. Particularly to enhance the patient's ability to plan her own diet for diabetic nephropathy and self-care, the author has applied some nursing measures such as the guideline of hygienic education, nutrition consultation, supporting and providing resources to help the case adjust stress as well as risk from the disease and hospitalization, and help her successfully confront the impact of first hemodialysis. The author used the 11 functional health-patterns designed by Gordon to evaluate, applied observation and interview technique to collect data, establish what the potential danger of infections would the case encounter and how the comfortable situations improved less than the requirement for the body---such as itchy skin, lack of relevant knowledge about the medical care in everyday life after hemodialysis, and nutrition changed---then supplied the optimal nursing measures based on all those information, and evaluated the effects of hygienic guideline by telephone interview and face-to-face interview at her back as an outpatient after hospitalization, so as to understand what problems would the hemodialysis novice met after going home, and provide follow-up nursing service, so as to beef up the patient's safety and confidence, reinforce her willing to take part in healthful activities and accommodate to the changes of lifestyles after hemodialysis.