照顧一位末期腎病變血液透析患者之護理經驗

Experience of Nursing a Hemodialysis Patient with End Stage Renal Disease

本篇係探討一位末期腎病變血液透析患者，於透析期間因水份控制不良造成體重增加過多，導致心臟衰竭併發肺水腫之護理經驗。護理期間自2008年9月22日至2008年10月12日止，筆者藉由會談、傾聽、身體評估、調閱病歷、配合臨床理學等收集資料。運用Gordon十一項健康功能進行評估，確立患者的護理問題為：體液容積過量、身體活動能力障礙、舒適情形改變及無望感。筆者根據學理教導患者水份控制、肌肉復健運動指導及減少肌肉痙孿方法，並運用治療性溝通技巧，與患者建立信任感，使其能以正向態度面對疾病衝擊，透過疾病護理教導使患者對疾病有正確的認知，協助患者渡過疾病療程。臨床護理人員應持續充實自我，多參與輔助醫療課程，拓展專業角色及功能，使患者護理問題能夠持續性獲得幫助與解決，進而提升患者整體之生活品質。

This report describes the experience of nursing a hemodialysis patient with end stage renal disease that experienced heart failure combined with pulmonary edema after excessive weight gain due to poor water control. The care period was from September 22 to October 12, 2008. The author collected information using interviews, attentive listening, physical assessment, chart review and clinical theory. Gordon's 11-item Functional Health Pattern was applied to evaluate the patient and identified the following care problems with the patient: excess of body fluid, impairment of physical mobility, change in comfortable circumstances and feeling of hopelessness. Drawing on clinical theory the author educated the patient about water control, muscle rehabilitation exercises and methods to reduce muscle spasm. Therapeutic communication skills were also used to build up trust and help the patient face the impacts of the disease with a positive attitude. Care instruction helped educate the patient about the disease as well. Clinical care personnel should continue to enrich themselves and to participate in paramedical courses. The expansion of professional roles and functions will ensure that patient care issues receive the continuous help and resolution they need to improve the patient's quality of life.