應用運動訓練於一位血液透析患者生理及心理成效之護理經驗

Improving Physiological and Psychological Status in a Hemodialysis Patient: A Nursing Experience Using an Exercise Training Program

運動訓練能改善血液透析患者之身體活動功能、營養狀況、降低心血管疾病危險因子、降低憂鬱及促進健康狀況。本文旨在探討應用運動訓練改善血液透析個案之活動無耐力、無力感及無效性健康維護能力之護理經驗。護理期間為2012年5月11日至7月27日。運用觀察、會談、身體評估及查閱病歷方式收集整體性資料，確立個案主要之健康問題為活動無耐力、無力感及無效性健康維護能力。除了提供個別性護理措施、藥物治療及飲食衛教，筆者設計一台固定式腳踏車可置於床尾，於個案接受血液透析治療期間提供運動訓練，每週三次，一次30分鐘，共12週。測量運動訓練介入前後之六分鐘走路距離、憂鬱及追蹤每月之血液檢驗值（三酸甘油脂、白蛋白、血紅素）。為了確保個案運動訓練之安全性，監測每次運動前後之血壓、心跳、血氧飽和度變化。個案於運動訓練第12週後，心跳速率可達最大心跳速率40%-60%，心跳從原本的每分鐘85次增至121次；六分鐘走路距離從210公尺增加至255公尺；三酸甘油脂從622 mg/dL降至173mg/dL，自覺頭暈及憂鬱亦明顯改善。冀望此護理經驗能提供護理同仁照顧此類個案之參考。

Exercise training during hemodialysis has been found to improve functional capacity, nutritional status, cardiovascular risk factors, depression, and well being in hemodialysis patients. This report describes a nursing experience that applied exercise training to improve activity intolerance, powerlessness, and ineffective health maintenance in a hemodialysis patient. The care period was from May 11 to July 27, 2012. The author collected information using observation, interview, physical examination, and medical record review and identified patient care problems including activity intolerance, powerlessness, and ineffective health maintenance. In addition to providing individual nursing interventions, the author designed a stationary bicycle installed at the end of the bed. The patient was asked use the bicycle to exercise 30 mins per time, three times per week for a period of 12 weeks during the patient's hemodialysis period. Before and after a 12-week of exercise training, collected the 6-minute walk test (6MWT), self-perceived improvement, and self-reported depression scales were performed prior to and after completion of the intervention. Hematological triglyceride, albumin, and hemoglobin data were collected each week. Heart rate, blood pressure, and oxygen saturation were examined prior to and after the intervention to ensure patient safety. After the 12-week intervention, the average heart rate achieved 40-60% of the maximum heart rate and the heart rate peaked between 85 and 121 bpm. Moreover, the 6MWT distance increased from 210 m to 255 m, triglyceride decreased from 622 mg/dL to 173 mg/dL, and self-perceived fatigue and depression markedly improved. This nursing experience is shared with nurses caring for patients with similar conditions.