照顧一位非ST段上升心肌梗塞併慢性腎疾病個案之護理經驗

The Nursing Experience of a Patient with Non-ST Elevation Myocardial Infarction and Chronic Kidney Disease

本文描述一位曾經接受暫時性血液透析治療六次之非ST段上升心肌梗塞(non ST elevation myocardial infarction, NSTEMI)併慢性腎疾病(chronic kidney disease, CKD)個案之護理經驗。護理期間自2009/3/30-6/15，運用觀察、會談、Gordon十一項健康功能型態及電話追蹤收集資料，發現護理問題有：健康尋求行為、潛在危險性體液容積不平衡、焦慮。筆者藉由個案維護健康的意願，給予鼓勵以促進個案維護個人健康的信心與能力，以有效延緩病情，避免進入長期透析階段；並協助個案評估其影響健康的不利因素後，透過自我效能的提升，成功地改變先前不當的飲食型態、運動習慣及抽煙嗜好。期間並透過持續每週一次近兩個月的電話追蹤評值，以增強個案持續維持健康的生活型態，使病程獲得最佳的控制，更提升了對健康維護的信念與信心。希藉由此成功案例提出分享，並作為護理人員日後照護之參考。

This report describes the nursing experience of a patient with non-ST elevation myocardial infarction and chronic kidney disease who underwent 6 temporary sessions of hemodialysis. Nursing assessment was based on Gordon's 11 multi-functional health scales, observations, interviews and phone follow ups from March 30(superscript th) to June 15(superscript th), 2009. The patient suffered from major nursing problems related to health-seeking behaviors, potential risk of body fluid imbalance and anxiety. The patient's healthcare awareness and self motivation, as encouraged by the author, will enable the patient to maintain his health status and effectively reduce the disease progress. Through evaluation of risk factors and enhancement of self-efficacy, the patient successfully modified his inadequate lifestyle related to diet, exercise and smoking. We also provided our weekly phone follow ups and found that within two months, the patient could maintain a healthy lifestyle and promote his disease control ability, healthcare beliefs and self-confidence. The author hopes to share this successful nursing experience for the future caring of CKD patients.