一位高血壓腎病變合併肺水腫患者接受血液透析之護理經驗

Nursing Experience on Hemodialysis Patient with Hypertension Nephropathy Combined with Lung Edema

本文旨在探討一位高血壓腎病變合併肺水腫患者接受血液透析之護理經驗。本個案因呼吸喘入院，在心理毫無準備下被告知需依靠洗腎維生，產生極大壓力而出現對疾病否認、不安及害怕之情緒反應。護理期間自2010年1月26日至2010年3月15日，藉由個案每週一、三、五下午到院透析時，運用羅式適應模式評估工具，並藉由觀察、會談、身體評估及病歷查閱等方式收集資料，確認個案主要的護理問題為：體液容積過多、焦慮、知識缺失（末期腎病的居家自我照顧）。藉由主動關懷、同理心及接受等支持性技巧與個案建立良好的護病關係，運用個別性護理並配合醫療措施改善其體液容積過量之生理問題，兩次洗腎之間維持正常之乾體重5%內，並提供疾病相關資訊和護理指導及結合支持系統協助個案克服心理壓力以減輕其焦慮，最後個案能坦然面對及接受洗腎，並積極執行治療性自我照顧。期望此護理經驗能提供臨床照護之參考。

The purpose of this study was to explore a nurse's experience of caring for a hemodialysis patient with hypertension nephropathy combined with lung edema.In this case, the patient was hospitalized for dyspnea then unexpectedly informed that he will be dependent on hemodialysis from now. The tremendous pressure this put on the patient led to symptoms of denial, fear and anxiety. The nursing period ran from January 26 through to March 15, 2010, and Roy's model was used to gather data when the patient underwent dialysis on Monday, Wednesday and Friday afternoons at the hospital. Data was collected through observation, communication, physical assessment and medical records. The main nursing problems we identified included excess fluid volume, anxiety and deficient knowledge (home care with final-stage renal disease). First, support skills such as caring, empathy and acceptance were used to build a positive relationship between the patient and nurses. For the physical problem of excess fluid volume, individual nursing and medical intervention were used to bring about improvements. The dry body weight between two hemodialysis sessions was kept within a 5% range, the patient provided with related disease information while nursing guidance and a joint support system helped the patient overcome mental stress and reduce his anxiety. Ultimately, the patient came to terms with dialysis and was able to actively administer therapeutic self-care. We hope that this nursing experience will provide a reference for clinical nursing care in the future.