照顧一位腹膜透析液滲漏導致肋膜積水之護理經驗

Nursing Experience if a Patient with Pleural Effusion Induced by Dialysate Leakage

本個案報告探討一位58歲男性，因尿毒症接受腹膜透析治療，由於透析液滲漏肋膜腔產生肋膜積水引發不適之護理經驗，筆者自97年5月26日至97年6月20日護理期間運用Gordon十一項健康護理型態評估，藉由會談、傾聽、觀察方法收集資料，發現個案透析液滲漏產生呼吸困難、胸悶、體重增加、水腫、以及併有營養不良及皮膚搔癢困擾，歸納個案主要護理問題有低效性呼吸型態、潛在危險性感染、營養不均衡：少於身體所需、睡眠型態紊亂。為緩解肋膜積水引發之不適，除利用手術修補橫膈膜，改善呼吸方面症狀，筆者主動積極關懷個案需求，並運用護理專業知識提供相關透析照護，指導個案學習自我飲食監測及紀錄每天飲食攝取的量及種類，藉以提升個案自我照顧能力，促使個案能持續腹膜透析，並維持良好的生活品質，且讓個案慢慢回歸家庭及社會。

This case report describes the nursing care experience of a 58-year old male with peritoneal dialysis experiencing discomfort due to dialysate leakage into pleural cavity. During the nursing period from May 26, 2008 to June 20, 2008, the author used Gordon's 11 item Health Nursing Pattern to collect information and data through interviews, listening and observation. The patient was found to be experiencing breathlessness, chest tightness, weight gain, edema, malnutrition and itchy skin issue induced by dialysate leakage. The patient's primary care issues included ineffective breathing pattern, potential risk of infection, imbalanced nutrition: less than body requirements and disturbed sleeping pattern. To ease the discomfort caused by pleural effusion, in addition to surgical repair of the diaphragm to improve the respiratory symptoms the author also actively cared for the patient's requirements. Nursing expertise was also used to provide professional knowledge on dialysis care, teaching the patient to monitor their own diet as well as record the types and amounts of food they ate every day. By enhancing the patient's self-care ability, the patient was encouraged to resume peritoneal dialysis, maintain a good quality of life and make a gradual return to his family and society.