一位紅斑性狼瘡患者首次接受腹膜透析之護理經驗

Nursing Experience from a Systemic Lupus Erythematosus Patient Receiving Peritoneal Dialysis for the First Time

本文主要描述一位紅斑性狼瘡患者併發末期腎病後首次接受腹膜透析之護理經驗。筆者於2007年1月3日至2007年2月9日護理期間透過觀察、身體評估、直接護理與會談方式收集資料，運用羅氏適應理論模式進行整體性評估，發現個案有體液容積過量、抉擇衝突、情境性低自尊、焦慮等健康問題。藉由信任感與夥伴關係之建立，協助個案瞭解抉擇衝突的來源，澄清價值觀及優先次序，透過衛生教育提供相關資訊及病友經驗分享，增進個案對疾病的認識，並實地參訪透析室瞭解血液透析與連續性活動性腹膜透析兩者間治療之差異，邀請案母共同參與治療，協助個案選擇合適的治療方式，運用放鬆療法降低對手術之焦慮狀態，讓個案早日學習腹膜透析照顧技巧，以達到自我照顧之目標。希望藉由此次的護理經驗，提供日後護理人員在面對相同疾病照護時的參考。

The aim of this article is to describe the nursing experience of an SLE patient with ESRD who received peritoneal dialysis for the first time. Information was collected via observation, physical examination, direct nursing and history taking from January 3, 2007 to February 9, 2007. In addition, Roy's Adaptation Model for complete evaluation was used, revealing that this patient had body fluid overload, conflict decisions, situational low self-esteem and anxiety. By establishing trust and partnership, the patient was assisted in making the appropriate medical treatment decision and prioritizing the patient's priorities. By providing health education and sharing experiences from other patients, we increased the patient's understanding of the concerned disease. Actual visits to the dialysis center helped the patient to differentiate between H/D and CAPD, while the patient's mother's participation assisted this patient in the selection of a suitable form of dialysis. Incorporating relaxation therapy, we have decreased the patient's anxiety regarding surgery, allowing the patient to learn the skills of CAPD self-care. It is our hope that through this nursing experience, we can help to enlighten other nursing staff members when encountering patients under similar situations.