照護一位末期腎病變初次血液透析病人之護理經驗

Nursing Experience for an End-Stage Renal Disease Patient Undergoing Hemodialysis for the First Time

本報告是描述照護一位因長期服用來源不明之傳統草藥而患有尿毒症之未婚女性，接受血液透析治療之護理經驗。護理時間自 2010年04月03日至22日，筆者在護理期間藉由會談、身體評估、實際照護方式及應用 Gordon十一項功能性健康型態評估等技巧收集資料，加以分析整理，確立個案主要健康問題為：體液容積過量、高危險性感染、知識不足及調適障礙。在照護過程中，針對個案健康問題給予整體性的護理措施，經由限水、飲食衛教及血液透析治療，改善生理的不適；提供傷口護理及預防感染措施，使導管、管傷口無感染情形發生；衛教個案，對新植入的動靜脈管，進行管照護衛教，加強其自我照護管的能力，以維持透析患者「第二生命線」的功能；了解個案對透析真正的感受與想法，澄清及修正錯誤訊息，加強支持系統建立，增加個案對接受血液透析的正向看法，協助個案身、心適應長期血液透析治療。筆者在個案出院後，仍透過電話訪談追蹤個案已能自我照護並規律的行血液透析，並能將血液透析列入日常生活必要執行的活動之一，而不至於影響日常生活的常規及活動。本文建議在照護慢性腎絲球腎炎之個案時，應該強調食用來路不明傳統草藥的嚴重後果，才不至於使病患步入長期血液透析階段。

This report describes the care experiences of an unmarried women suffering from uremia receiving dialysis due to long-term use of unidentified herbs. The care period was April 3 to 22, 2010. The author applied interviews, physical assessments, and Gordon's 11 functional health patterns to collect data for analysis. The following health problems were identified for the patient: excess fluid volume due to chronic renal failure, high risk from infection from double lumens indwelling, insufficient knowledge and adjustment disorders. During the care period, the author provided the patient with holistic nursing on the identified health problem. Physical discomfort was alleviated through restricting fluid intake, diet and health education and hemodialysis. Wound care and infection prevention measures prevented the infection of the double-lumens and fistula wounds. Case studies of the newly implanted arteriovenous fistula were used for fistula care education to enhance the patient ability to care for the fistula and keep the ”Second Lifeline” in working order. Empathy was used to understand the patient’s true feelings and thoughts, clarify and correct misinformation, strengthen the support system and make the patient feel more positive about hemodialysis so she can adapt physically and mentally to long-term hemodialysis. The author also interviewed the patient over the phone after discharge to confirm that this patient could perform self-care and continued to undergo regular hemodialysis as part of her normal routine. The author recommends that the serious consequences of using unidentified herbs should be stressed to patients with chronic glomerulonephritis so they do not end up requiring long-term hemodialysis.