照顧一位糖尿病合併末期腎病血液透析病患之護理經驗

Nursing of Experience for Hemodialysis Patient with Diabetes and End Stage Renal Disease

本篇是探討一位羅患糖尿病合併末期腎病的男性病患，在接受血液透析後因體液容積過量，面臨透析中急性併發症－－抽筋的困擾及其對身體健康狀態改變的心理衝擊。護理期間自2008年5月31日至2008年6月30日，運用觀察、會談、病歷及Gordon十一項健康功能評估方式收集資料，加以分析整理。發現個案面臨透析不適的症狀，而產生種種壓力，其健康問題包括：潛在危險性創傷、體液容積過量、調適障礙。筆者在護理過程中針對個案健康問題，給予水份控制、飲食指導的護理措施，教導居家安全、預防跌倒衛教改善生理之不適。運用傾聽、同理心，給予個案鼓勵與支持，協助其維持正常透析生活並提供相關資料，讓個案瞭解血液透析的重要性，協助個案調適焦慮重拾笑容。雖然，血液透析對個案來說是長期治療。但是，透過不同的方式來執行個別且持續性的護理，如此才能使個案真正接納血液透析，提昇其生活品質。

The study explores the psychological impact on a male diabetic patient with End Stage Renal Disease (ESRD) affected by acute dialytic complication in the form of seizures caused by excessive fluid volume as well as its adverse effect on his health. Data was collected and analyzed during the care period between 5/31/2008 and 6/30/2008 using the Gordon health evaluation methods, observations, interviews and case history. The author found that the case was stressed by symptoms of dialytic maladjustment. The health hazards included: risk for injury, excessive fluid volume and impaired adjustment. During nursing care the author focused on the followingpatient health issues: water intake, nutrition, home safety, fall prevention and health education for coping with physical discomfort. Through patient attention and empathy, efforts were made to encourage and support the patient to live a normal life while receiving dialysis. The patient was also provided with information on the importance of hemodialysis to help him relax and enjoy life again. While hemodialysis is a long-term process for the patient, individualized and continuous nursing care can be provided to help the patient come to terms with dialysis and improve his quality of life.