協助一位慢性腎臟疾病患者接受腹膜透析預先植管的護理經驗

Experience in Nursing: Helping a Chronic Kidney Disease Patient to Accept Stepwise Initiation of Peritoneal Dialysis

腎臟替代療法是末期腎臟病賴以維生的處置，本文在描述一位41歲慢性腎臟疾病患者接受階段式腹膜透析廔管的護理照護過程。護理期間為2006年11月10日至2007年4月30日，筆者以觀察、會談、病歷查閱、住院的探訪及電話的關懷方式收集個案相關資料，並用Gordon十一項健康功能型態及身體評估為工具，發現個案有抉擇衝突、焦慮、潛在危險性感染、性生活型態改變等健康問題。藉由護理指導提供整體性、連續性的護理措施，協助個案渡過選擇腹膜透析面臨預先廔管的調適過程、減輕廔管手術的焦慮、預防手術傷口感染及改善因疾病造成性生活型態改變等問題，給予適切的護理活動，使個案能夠克服生理的問題及心理的障礙，平順安全地接受後續的腹膜透析治療。

To persuade uremic patients to receive peritoneal dialysis (PD) as the model of renal replacement therapy requires intensive education and communication with the patients. Stepwise initiation of PD (SIPD) through the pre-set implantation of a PD catheter has recently been implemented in our hospital to ensure a timely and smooth initiation of PD. SIPD has successfully spared patients from unexpected insertion of temporary venous catheter and emergency hemodialysis. Here, we reported our nursing experience concerning a 41-year old female ESRD patient receiving SIPD. We collected the data on the patient from November 10, 2006 to April 30, 2007, through observation, chart review, face-to-face conversation, and telephone counseling. The condition of the patient's health was evaluated by the Gordon 11-item Functional Health Pattern Assessment Method. We found that the patient experienced anxiety because of uncertainty and problems related to decision-making, worry about the potential risk of infection, and changes in her sexual life. Through an integrated and continuous nursing care program, the patient eventually overcame her fear and was willing to receive SIPD. Our program also includes proper education on wound care, thus decreasing the potential risk of infection. The results demonstrate that this CKD nursing program is capable of solving both the physical and psychological problems of uremic patients, while they are facing the puzzling nature of renal replacement therapy.