照顧一位慢性腎臟病孕婦之護理經驗

The Nursing Experience of a Pregnant Woman with Chronic Kidney Disease

末期腎臟病患者懷孕是件非常不易的事，隨著孕程的進行，伴隨著許多的危機。本文為照顧一位罹患末期腎臟病初次懷孕，於26週胎死腹中個案之護理經驗。筆者於96.7.23至96.11.21應用羅氏適應模式，藉由觀察、會談、身體評估等方式收集資料，發現個案有抉擇衝突、知識缺失、營養狀況少於身體所需、潛在危險性感染、哀傷功能失常的問題。護理過程中運用關懷、同理心及接受等技巧與個案建立互信之護病關係，讓個案及家屬能瞭解腎臟病與懷孕相互影響之關係，協助決定是否完成孕程，並提供護理指導與諮詢。於個案懷孕26週面臨孕育失敗的衝擊時，更主動關懷、傾聽，適時主動與家屬一同協助個案度過哀傷期。筆者期藉由此篇個案報告，分享給腎臟照護相關之護理人員，作為照護類似個案之參考。

It is not easy for a patient with advanced CKD to become pregnant, but once she is pregnant the physiological changes of gestation will greatly increase the burden on the mother with the attendant risks of deterioration of renal function, eclampsia, and hazards to fetal development and survival. This report describes the nursing experience in caring for a patient with advanced CKD, having a primiparous 26(superscript th) week of gestation, but with an outcome of intrauterine fetus death. From July 23(superscript rd) to November 21(superscript st) 2007, we used the ”Roy adaptation model” to observe, assess, communicate with, and perform physical skill tests on this patient. Four[A1] main domains on health problems were determined: ”Decision making”, ”Knowledge deficit”, ”Nutrition less than body requirements”, ”Risk of infection”, and ”Dysfunctional grieving”. By giving sincere concern, sympathy, and acceptance during the nursing process, a relationship based on trust was established between the nurse and the client. We helped the patient and her relatives to understand the relationship between kidney disease and pregnancy, and how they influence each other, in the process of helping them to decide whether or not to proceed with the pregnancy, and offering relevant nursing guidance and consultation during the gestation. When the patient was faced with the impact of fetal death at 26 weeks, we actively provided care and voluntarily offered our concern at the appropriate time to pass through this time of grief with the relatives. Nursing experience will be shared as reference for those who might deal with a similar situation in the future.