一位成年人腎移植衰竭後接受血液透析之護理經驗

Nursing Experience: An Adult Patient's Repeat Renal Failure after Renal Transplantation and Return to Hemodialysis

本文為一位成年人自行停用免疫抑制劑，造成移植腎衰竭接受血液透析之護理經驗。筆者於個案透析期間運用以觀察、會談及Gordon健康功能型態評估收集資料，確立其護理問題：體液容積過量、知識缺失、個人因應能力失調。護理過程中主動關懷個案並建立良好的護病關係、提供個別性及獨特性護理活動，使個案能將每次透析脫水量控制在乾體重的百分之五以內，並了解規則血液透析及服藥的重要性，提升個案的透析品質。同時，運用社會資源及團隊照護，減輕案母照顧個案的壓力，並且引導個案檢視透析前後身體狀況的差異及期許未來，協助個案重新適應血液透析的生活，並回歸社會。期盼藉此護理經驗與臨床護理人員分享，以提升此類病患的全人照顧能力。

The article covers the care giving experience with an adult patient who decided to stop taking immunosuppressants following renal transplantation, suffered repeated renal failure and returned to hemodialysis. During patient hemodialysis, data was collected through observation, interviews and Gordon's Functional Health Patterns verified that the patient had the following problems: excess fluid volume, knowledge deficiency and inadequate coping skills. During the care giving process, the caregiver's active care strengthened the caregiver-patient relationship and provided the individual with unique care activities. These efforts improved hemodialysis quality, enabling the subject to limit fluid removal to less than 5% of the hemodialysis dry weight for each session as well as getting the patient to understand the importance of regular hemodialysis and medication. Social resources and team care also alleviated the pressure on the patient's mother and allowed her to return to work. The assessment was made in order to determine the pre- and post- hemodialysis difference in physical condition and hopefully, help the subject readjust to the hemodialysis routine. The sharing of this care experience with other clinical nurses will hopefully enhance the holistic care for other patients in a similar condition.