照顧一位多囊腎個案感染沙門氏桿菌腸炎之護理經驗

Experience in Caring for a Patient with Salmonella Enteritis and Polycystic Kidney

本文旨在敘述一位遺傳體顯性多囊腎疾病(autosomal dominant polycystic kidneydisease, ADPKD)之中年婦女，因感染沙門氏桿菌腸炎引發敗血症，導致急性腎臟及呼吸衰竭之護理經驗。護理期間從2007年10月10日至2007年10月23日，經由傾聽、會（筆）談、觀察、身體評估、臨床照顧等方式收集資料，並以Gordon十一項功能性健康型態進行護理評估，了解個案因遺傳疾病加上感染沙門氏桿菌腸炎引發合併症，造成身、心的衝擊，確立個案有急性疼痛、腹瀉、焦慮等護理問題。在護理過程中，藉主動探視、陪伴、監測和紀錄病況進展，做好腸道隔離措施，注意個案水份、電解質平衡及舒緩疼痛，讓個案了解疾病的變化及治療計畫，減輕其焦慮並增加個案的安全感，讓個案免於接受血液透析治療，希望藉此護理經驗與他人分享。

This report describes the caring experience for a female patient with autosomal dominant polycystic kidney disease (ADPKD). The patient had been infected with Salmonella enteritis that evolved into sepsis, acute renal failure and respiratory failure. The period of care was between October 10~27, 2007. The author collected data through listening, face-to-face (written) discussions, monitoring, physical assessments and clinical caretaking of the patient. Gordon's 11 Functional Health Patterns were carried out at the same time to better comprehend the physical and psychological impacts from the patient's genetic disease and complications resulting from Salmonella enteritis. Caretaking problems identified included acute pain, diarrhea and anxiety. During the caretaking period, proactive visitations, companionship, monitoring, documentation of the disease progression as well as attention directed at enteric isolation measures, fluid and electrolyte balances and pain relief, helped the patient understand how her disease was progressing and what her treatment plan was. The efforts reduced patient anxiety, built up a sense of security and averted the need for hemodialysis. This case report will hopefully help share the caretaking experience with other care providers.