一位乳癌婦女併發尿毒症接受腹膜透析治療之護理經驗

Nursing Experience of Caring a Woman with Breast Cancer Complicated by Uremia Undergoing Peritoneal Dialysis

本文旨在描述一位乳癌婦女面臨術後化療、放射治療而導致腎功能急速惡化，並接受腹膜透析治療之護理經驗。筆者於 99年6月14日～99年7月20日，藉由觀察、會談、傾聽、直接身體評估及數次電訪和居家訪視等方式收集資料，並運用羅氏適應理論，進行個案整體性評估，發現個案在生理層面及心理層上有知識缺失、身體心像改變及潛在危險性感染之健康問題。照護期間採主動關懷的態度，與個案建立良好的互信關係，針對其護理問題，整合所有可利用資源，提供個別性、持續性的完整照護，確實改善疾病引起的不適感，增加個案自我照顧能力。筆者運用同理心陪伴個案面對在半年內接踵而來的兩項重大疾病所造成的巨大衝擊，採用的方式包括：耐心傾聽，鼓勵說出心理感受，並介紹病友互動，提供經驗分享，促使個案能以健康正向態度適應生活型態之改變，接受與疾病共存的事實。冀望藉由此個案報告護理經驗分享，做為日後類似個案照護之參考。

This paper described the nursing care experience for a female patient with breast cancer who underwent peritoneal dialysis due to rapidly worsening renal function during postoperative chemotherapy and radiotherapy. All information was collected by the author via observation, interviews, physical examination, home visits and telephone interviews between June 14 and July 20, 2010.The patient was evaluated using the Roy adaptation model and some health problems in both the physical and mental aspects were discovered: deficient knowledge, disturbed body image and risk of infection. During the nursing period, a proactive attitude was adopted towards the patient and mutual trust established. All available resources were coordinated to provide personalized and continuous integrated care for her nursing problems in order to improve her disorders' associated discomforts as well as to promote her self-care ability. The author also showed empathy to the patient to help her face the enormous impact from the two major disorders within a six-month period. We helped the patient adapt to the change of lifestyle in a positive and healthy manner as well as come to terms with the disorders by listening to her patiently, encouraging her to talk about her feelings and introducing her to other patients with similar experiences. The nursing care experience shared here will hopefully provide a useful reference for the caring of similar cases in the future.