照護一位末期腎疾病患者面對血液透析治療之護理經驗

Nursing Experience of a Patient with End Stage Renal Disease with Hemodialysis

本個案報告是在描述照護一位末期腎病患者接受血液透析治療之護理經驗。護理期間自95年05月08日至95年05月20日，筆者在護理期間經由身體評估、觀察、會談及應用Gordon十一項功能性健康型態評估等技巧收集資料，加以分析整理，確立問題。在護理過程中發現個案因末期腎衰竭並接受血液透析治療，生理上產生營養不足、人工導管旁有抓痕及小紅點等問題；在疾病認知上也缺乏足夠的資訊，造成心理的焦慮，因此歸納出個案主要的護理問題有：營養少於身體所需、知識缺失、潛在性感染等健康問題。經由主動關懷個案需求，並透過護理活動的介入，降低個案因疾病所引起的營養及潛在性感染等問題，另針對個案對血液透析治療認知之疑慮處，協助澄清，配合衛教單的使用，強化個案對疾病的了解，以減輕心中的焦慮達到整體性護理的目的。鑑於末期腎病患者接受血液透析治療的病患日漸增多，筆者藉此個案報告的護理經驗提出與護理人員分享，以做為日後照護此類病患的參考。

The case report describes the nursing experience of a patient with end stage of renal disease with hemodialysis from May 08 to May 20, 2006. The author utilized Gorden's 11 multi-functional health scales for collecting information; to analyze and sort out the problems based on his physical assessment, close observation and intensive interviews with the patient. The findings during nursing evaluation indicate that malnutrition, lack of medical knowledge (i.e. the scratches and red rashes around the blood vessel) coupled with potential danger of infection were recorded as key factors contributing to the patient' anxiety status due mainly to the lack of concrete associated medical information and attention. In conclusion, the major nursing problems are: patient' malnutrition, inadequacy of knowledge and the potential danger of infection. Through caretaker' active care and concern, more lectures or related activities are suggested to offer them know-how, while easing their anxiety status. In addition, medical booklets can be delivered regularly to clarify and reinforce their medical understanding. With the increasing cases of patients with end stage renal hemodialysis, this case report may provide some valuable information for the nursing staff in order to enhance their ability to provide comprehensive care.