照顧一位末期腎病患者成功改變治療模式之護理經驗

Nursing Experience with an End-Stage Renal Patient Who Successfully Changed the Treatment Mode

本文探討一位 50歲末期腎病女性病人，發生黴菌性腹膜炎而拔除腹膜透析導管，改變透析模式轉而接受血液透析後所經歷的身心衝擊等問題。護理期間為民國100年2月4日至2月18日個案住院期間，藉由觀察、會談及病歷查閱等方式收集資料，運用羅氏適應模式進行評估，確立護理問題有：急性疼痛、潛在危險性感染、無效性健康維護能力與否認行為不當。在護理過程中秉持關懷照顧的精神，扮演著支持者、諮詢者與傾聽者的角色，引導及了解個案內心的感受及需要，針對急性疼痛利用按摩、聽個案喜愛的佛經等放鬆技巧後，疼痛獲得緩解；及給予血液透析雙腔導管與飲食相關衛教指導，個案已能正確執行換藥技術、辨別感染的徵象，並瞭解不同的透析模式在飲食上之異同處，且正確執行飲食的控制；透過護理活動的介入，與個案建立良好的病護關係與支持系統，使其坦然面對疾病的發展，得到正向的適應以修正否認不當之行為，促使個案能夠成功接受透析治療模式的改變，面對未來的生活。鑑於末期腎病接受透析治療的病人，因病情需要會面對不同的治療方式，其所產生身、心層面的問題，期望藉此本文與護理同仁分享照護經驗。

This paper is about overcoming the physical and mental impacts on a 50-year-old female end-stage renal patient that had contracted fungal peritonitis and had to switch to hemodialysis after removal of the peritoneal dialysis catheter. The period of care lasted was the two weeks between February 4 and February 18, 2011, when the patient was hospitalized. Patient information was collected through observation, inspection and discussion then assessed using the Roy adaptation model. The care problems identified included acute pain, risk of dangerous infections, ineffective health maintenance and denial of improper behavior. During the nursing period, we assumed the roles of supporter, consultant and listener to guide and understand the feelings and needs of the patient while keeping her spirits up. It has been discovered that relaxation techniques such as massage and playing the patient's favorite Buddhist chants helped dramatically with relieving acute pain. After the nurses gave her dietary guidance and double-lumen catheter-related health education the patient was also able to change dressings properly, identify signs of infection, understand the nutritional and dietary details for different modes of dialysis, and accurately enforce diet control. After we established a good relationship and support system with the patient through care involvement, the patient was able to come to terms with the disease and correct improper behavior through positive adaption. As a result, the patient not only accepted the change of dialysis mode but also the new life style. End-stage renal patient forced to change treatment modes are vulnerable to the difficult physical and mental problems. This paper aims to share the experience of nursing these patients with other colleagues.