照護一位接受長期血液透析合併失智症病人之護理經驗

Nursing Care Experience for a Long-term Hemodialysis Patient with Dementia

本文為探討一位長期血液透析個案，因失智症合併慢性混亂症狀之護理經驗。護理期間自2008年8月12日至2008年12月1日，筆者經由觀察、會談、直接照顧及應用Gordon十一項健康功能型態評估發現個案有電解質不平衡、慢性混亂、主要照顧者無助感等護理問題。在護理期間與個案及家屬建立信任感及治療性人際關係，藉由提供飲食指導、加強重複、安心、轉移焦點、增強時間感及調整透析時間等護理措施，使得個案症狀得以改善；主要照顧者方面，經由提供其心理支持、了解失智症的照護知識及社會相關資源等，進而增加照顧者被支持的感受及壓力的抒發。終能有效的協助個案解決主要的健康問題，進而維持個案血液透析治療的完整性，並改善家屬照顧上的困擾。

This case report indicates a nursing experience for a long-term hemodialysis patient with dementia that induced confusion from August 12, 2008 to December 1, 2008. The author found the case to have an electrolyte imbalance and chronic confusion; according to the observation, interviews, direct participant nursing, and Gordon's 11 Functional Health Patterns tool, the caregiver felt helpless. In order to improve the situation of the case, a therapeutic relationship based on trust was built between client and nurses, and through the provided diet instruction, the case was encouraged and reassured to repeat, redirect, and adjust the time of dialysis treatment. The medical team also provided support and relief on the stress, mental support, as well as knowledge about dementia nursing, and the relevant social resources. Moreover, the caregiver also helped the case solve her main health problem effectively, successfully sustained the completeness of the dialysis treatment, and reduced the distress level of the family.