初次接受血液透析之慢性腎衰竭病人護理經驗

Clinical Experience of Providing Nursing Care for a Chronic Renal Failure Patient Receiving His First Hemodialysis

本文探討一位慢性腎衰竭病人因面臨腎功能惡化，初次接受血液透析治療並行人工動靜脈瘻管置入手術之護理經驗。筆者於2009年6月23日至6月29日，運用Gordon 11項健康功能型態評估後，確認個案有急性疼痛、潛在危險性感染、無望惑之護理問題。無望感對個案在疾病治療認知上影響甚大，護理期間藉由文獻查證提供個別性護理措施，首先建立良好的護病關係及增加信任感，協助個案面對疾病導致生、心理變化時，能找回對生命的信心與希望。另外，由於個案初次接受血液透析治療，須面對人工動靜脈瘻管置入後產生的傷口疼痛惑，及返家後自我照護之問題，藉由此次的護理過程已提供個案完整的護理指導，減少合併症發生，以獲得生活品質的提升。

This case study describes nursing management of a patient with chronic renal failure undergoing arteriovenous graft placement and hemodialysis for the first time. Nursing problems identified by the author between June 23 and June 29, 2009, included acute pain, potential infection risks and hopelessness using Gordon's Functional Health Patterns. Hopelessness in particular greatly affected the patient's understanding of the disease and treatment. After reviewing the literature, we built up trust and a good relationship with the patient through an individualized nursing intervention to help the patient cope with the physical and emotional changes caused by the disease. The goal was to restore the patient's hope and faith in life. As a new hemodialysis patient, the patient struggled with managing wound pain after arteriovenous graft placement and was expected to encounter self-care problems after discharge. During the nursing care, we not only helped the patient overcome the emotional barriers but also provided comprehensive care instructions that successfully reduced complications and improved quality of life.