照護一位體液容積過量之老年血液透析患者的護理經驗

A Nursing Care Experience of a Gerontic Hemodialysis Patient with Body Fluid Overload

本文探討一位74歲已接受長期血液透析2年的女性個案，因水份控制攝取不當而導致體液容積過量，同時家屬計畫讓個案到安養院療養，引起個案心理衝擊等問題。對一位長期血液透析的患者來說，透析結束時達到設定的乾體重相當重要，若長期無法達到乾體重，表示個案水份控制不當，影響心臟廔管系統，導致高血壓，嚴重時會形成左心室肥大、充血性心衰竭，並造成肺廔管壓上升引起肺水腫及週邊組織水腫。筆者於護理期間（2005年5月1日至2005年8月30日）經觀察及會談等方式收集資料，以Gordon十一項健康型態評估，發現個案有1.體液容積過量2.高危險性皮膚完整性受損3.睡眠型態紊亂4.遷移壓力等護理問題。並發現個案於94年4月就有體重累積之現象無法達到乾體重，所以筆者最優先的護理為加強家屬及個案了解體液容積過量後對身體健康的危害性，並設計一份限水、鹽的飲食，經半個月努力後達到改善其睡眠及皮膚之問題。針對遷移壓力，筆者建議家屬給予個案多項選擇並有決策的機會，鼓勵個案與家人互相分享。在透析時筆者接受個案不滿的情緒，鼓勵其表示心中的感受，盡量配合個案習慣，讓個案順利接受安養院的環境，整合所有的資源提供個別化的護理，使個案改善身、心的健康問題，並能以正向的態度面對日後的透析生活。

The study aims to understand a 74-year old female patient who has been undergoing hemodialysis for two years and because bad water control caused body fluid overload. Meanwhile her family members have suggested that she should stay in a nursing home for the elderly. Therefore the psychological impact of the move is also examined. For a patient who has experienced long term hemodialysis, a dry weight has to be kept after the treatment. If there's problem with bad water control, the patient may develop heart disease, high blood pressure, and angiopathy. Other ailments that might be caused by bad water control are left ventricular hypertrophy, congestive heart failure, pulmonary edema and peripheral edema, especially when the blood pressure in the lung is extremely high. The researcher carried out the observations and interviews from May 1 to Aug. 30, 2005 and the collected data were evaluated by Gorden's Health Pattern Typology. The patient suffered from (1) body fluid overload; (2) skin damage; (3) sleeping problems and (4) transferring pressure. Since April 2005, her weight cannot be maintained at the standard value. A priority of the nursing principle is to help the patient and her family members understand the danger of body fluid overload. Dietotherapy is designed to control water and salt in food. After 15 days of dietotherapy, her skin and sleeping problems were solved. The researcher proposed that the family members should give the patient more choices regarding where she should live and encourage her to share her feelings with them. Empathy between the patient and her family was improved as the patient was encouraged to express her feelings. The nursing home for the elderly was introduced and based on her living habits, arrangements were made for her stay. All resources were integrated in order to provide individual nursing care. As we can see from this research, issues between psychology and physiology can be improved and patients can face hemodialysis in a positive manner.