照顧一位獨居尿毒症患者多次血管栓塞之護理經驗

Nursing Experience with Caring For a Solitary Uremic Patient that Suffered from Frequent Shunt Occlusion during Hemodialysis

本個案報告描述一位獨居尿毒症患者，接受血液透析治療期間，因多次管通路阻塞面臨重建手術困擾之護理經驗。筆者自2007年9月18日至10月15日護理期間運用Gordon十一項健康功能評估，並藉由觀察、訪談、傾聽及身體評估等技巧收集資料。確立個案主要健康問題有：1.舒適障礙／與血管通路栓塞、術後疼痛腫脹有關；2.焦慮／與血管多次阻塞的痛苦經驗及重建手術後未知結果有關；3.家庭運作過程失常／因獨居，主要照顧者為不定時探望，溝通聯繫不易致無法清楚傳達與接受訊息有關。照護期間運用主動關懷、傾聽病患的需求，建立良好的護病關係，提供血管護理相關訊息及心理壓力之調適技巧，且利用單位製作之腎臟疾病護理衛教單，及教導日常生活照護重點並回覆示教，以提升個案本身及家屬對腎病的認知及照護技巧，期間以電訪建立醫院與家庭照顧者對於討論照護問題之聯繫方式。經由以上照護，疼痛及不適的情況得以改善，且家屬能配合參與居家照護，至2008年3月止，個案管無阻塞情形，仍持續追蹤。由護理經驗得知，護理人員對長期接受透析之個案及家屬提供居家照護且能落實透析相關衛教是非常重要的，同時要增進主要照顧者對血管通路照護能力及認知，使個案能得到持續性、完整性的照顧。

This report describes the nursing experience with caring for a solitary uremic patient that suffered from frequent shunt occlusion during hemodialysis. The patient's health condition were assessed with the Gordon functional health pattern as well as conventional means such as observation, conversation, listening and physical examination between September 18 and October, 2007. The patient was diagnosed with three major health problems: 1. Impaired Comfort-This was related to the occlusion of vascular access and painful swelling post surgery. 2. Anxiety-This was related to the pain caused by frequent shunt occlusion and the uncertain outcome of angioplasty. 3. Dystunctional family processes-This was related to the irregularity of visits by the primary care provider and the patient’s difficulty in making contact to communicate his messages. Methods such as showing active concerns and listening to the needs of the patient were adopted to establish a good relationship between the patient and the nursing team. Knowledge on caring for the shunt and the coping skill were also passed on to the patient for his well being. An educational leaflet on renal disease care was produced to teach the patient and his family about daily care and improve their understanding of renal diseases and nursing skills. As a result, good rapport was established between the family and the hospital. Not only did this help to alleviate the patient's pain and discomfort it also enabled his family to give support by providing effective home care. As of March 2008 there had been no recurrence of shunt occlusion and we are continuing to monitor the patient's condition. The importance of providing home care skills and the necessary educations to the patient and family cannot be understated as it promotes the patient's understanding and ability to care for vascular access.