一位因瘻管感染併發主動脈瓣閉鎖不全透析患者之護理經驗

Nursing Experience on a Dialysis Case with A-V Fistula Infection Complicated by Aortic Insufficiency

本文主在描述一位43歲長期血液透析患者因瘻管感染併發主動脈瓣閉鎖不全，引發心臟及性生活功能障礙，並面臨抉擇是否接受心臟手術之護理經驗。護理期間自2009年10月26日至12月28日，運用Gordon十一項健康功能評估及觀察、會談技巧、查閱病歷等方式蒐集資料，加以分析整理，確立問題。確立個案主要健康問題為：動靜脈瘻管功能失效、心輸出量減少、性生活型態失常、抉擇衝突。在護理期間，筆者運用同理心、傾聽的態度，建立專業信任關係，鼓勵個案表達出心中的擔憂、害怕與不安，提供疾病相關訊息，給予時間考慮、自我抉擇機會，指導個案調適身心、社會、經濟各方面壓力，並協助個案與心臟科、腎臟科醫生會談討論治療方針，增加個案對疾病的正確認知，正面處理夫妻間性生活問題，克服內心的障礙終能面對疾病，做出最佳的抉擇並接受自己的決定，期許此個案報告作為血液透析護理人員未來照護此類個案之參考。

This paper describes nursing experience with a 43-year-old patient with long-term hemodialysis complicated by aortic insufficiency and considering heart surgery. The nursing period ran from October 26 through to December 28, 2009. Gordon's 11 functional health assessments was used to collect data via observation, interviews and medical records. Four major health problems were determined in this case: function failure of artificial vascular circulation, decreased cardiac output, sexual dysfunction and decisional conflict. During the nursing period, the author established a relationship of professional trust with the patient by showing empathy, attentive listening and encouraging the patient to be frank about concerns, fears and anxiety. The author also provided the patient with disease-related information, gave the patient time to consider their options and make a decision. In the meantime, the author helped the patient adapt and adjust to physical, mental, social and economic pressure. Meetings with doctors from cardiology and nephrology doctors to discuss treatment guidelines were organized for the patient as well. The aim of the author was to educate the patient about the disease and help the patient overcome the obstacles. The patient can then confront their heart disease, make the best choices then come to terms with that decision. This report will hopefully provide a useful reference for hemodialysis nursing care in the future.