照顧一位血液透析病患因搔癢導致身體心像紊亂之護理經驗

A Nursing Care Experience of a Hemodialysis Patient with Pruritus for Body Image Disturbance

本篇報告主要是在探討一位血液透析個案，因全身搔癢導致身心紊亂的護理經驗。護理期間96年5月21日至96年7月11日，筆者藉由會談、觀察、護理活動、查閱病歷等方式收集資料，以”Gordon十一項健康功能型態”為評估架構，確立個案有皮膚完整性受損、身體心像紊亂、體液容積過量、睡眠型態紊亂等護理問題。筆者以同理心建立良好的護病關係，將個案的問題做整體性的護理計劃。針對皮膚搔癢部份，除提供足量透析，低磷飲食衛教及皮膚照護方式外，並運用藥膏加上一般身體乳液稀釋比例為1：2的創意讓個案塗抹於患部，使用後效果佳並且改善個案的外觀，協助個案減少抓癢及處理身心的健康問題，使個案可以積極正向的態度，面對因皮膚搔癢帶來外觀上的改變及疾病身心壓力的調適，並使個案重拾信心，走入社會。

This report describes the experience of nursing a hemodialysis patient who suffered from physical and mental disorders induced by pruritus. During the nursing period, from May 21st 2007 to July 11th 2007, the writer collected information using face-to-face interviews, observation, devoted nursing care and chart review. Gordon's 11-item Functional Health Pattern was applied to evaluate the patient and the nursing problems were established as impaired skin integrity, disturbed body image, excess fluid volume, and disturbed sleep pattern. Through a therapeutic nurse-client relationship, the writer provided information regarding professional patient care, especially with regard to the skin itchiness, adequate hemodialysis, and low phosphate diet education. Skin care was supported and diluted ointment, mixed with body lotion at the ratio 1:2, was applied to the affected area. Results demonstrated that nursing interventions helped to relieve pruritus, physical and mental disorders, improve the patient’s self-confidence and help the patient return to the society.