照護一位末期腎病病人初次面臨血液透析之護理經驗

Nursing Experience of a Patient with End Stage Renal Disease Faced with the First Incidence of Hemodialysis

本文旨在描述一位因Goodpasture's syndrome導致末期腎病而須長期接受血液透析個案之護理經驗。護理期間筆者經由直接照顧、觀察及會談方式收集資料，並以Gordon 十一項健康功能評估分析歸納個案主要護理問題為急性疼痛、現存性感染、疲憊及無望感。照護過程中筆者透過主動關懷個案建立良好護病關係，運用轉移注意力及止痛劑來減輕疼痛、教導動靜脈雙迴路瘻管及動靜脈瘻管照護之正確方法來預防感染、提供血液透析之相關醫療訊息以及給予心理支持等護理措施，終於使個案能由消極轉為積極的面對血液透析治療，並提升自我照顧能力，學會動靜脈雙迴路瘻管及動靜脈瘻管照護之各種注意事項，且調適血液透析帶來之改變，面對未來的生活。

The purpose of this article is to describe the nursing experience of dealing with a patient at the end stage of renal disease caused by Goodpasture's Syndrome with long term hemodialysis. We collected the data via primary care observation, discussion and the Gordon functional health assessment guide. Major nursing problems include: acute pain, infection, fatigue and hopelessness experienced by the patient. During the process, the author has provided the patient with cautious care, relieving pain by diverting the patient's attention and also using analgesics to prevent infection through proper attendance to double lumen and arteriovenous fistula procedures, and also the provision of related information on hemodialysis and psychological support. Finally, We helped the patient develop a positive attitude towards facing hemodialysis, enhanced her self-caring ability, gained knowledge in the important methods of care pertaining to double lumen and arteriovenous fistula, and in accepting and adapting to the changes that hemodialysis has brought to her life.