一位接受腎臟移植手術病患之護理經驗

The Nursing Experience of Postoperative Care of a Kidney Transplant Patient

本篇是描述照護一位末期腎臟疾病女性以腹膜透析方式治療半年後，順利接受活體捐贈的腎移植手術之護理經驗。筆者於2013年09月05日至22日照護期間，藉由身體評估、觀察、會談並運用Gordon 11項健康功能型態進行評估，確立病人有急性疼痛、潛在危險性感染及焦慮健康問題。在護理過程中筆者針對病人術後急性疼痛教導病人放鬆技巧，並依醫囑給予止痛藥，緩解病人疼痛。藉由建立治療性關係，教導病人需加強洗手、出入公共場所需戴口罩、避免生食、每日定期監測體溫等方式預防感染。然而移植後病人必須終身規則服用免疫抑制劑，感到焦慮，安排藥師給予藥物指導，與病人討論所使用免疫抑制劑，病人能說出腎臟移植後的使用藥物種類、作用及服藥時間，而降低個案不安，並結合其他專業團隊進行腎移植後的飲食衛教，提供個別性的照護，以提昇病人生活品質。建議臨床照護上，提供腎臟移植相關照護衛教及免疫抑制劑服用之衛教網址，增訂相關照護準則，和製作出院服務資料夾，提供病人自我照護知識技能手冊等方式，促使病人及其家屬瞭解移植後居家照護與終身服用藥物重要性，並提升出院準備服務完整性。

This article describes the nursing care of female who was diagnosed end-stage renal disease and received peritoneal dialysis treatment by CAPD implantation for six months. Then she accepted a living donor in kidney transplantation successfully. The period of nursing care was from 2013/09/05 to 2013/09/22. The patient was assessed using Gordon 11 function health patterns, with the data collected and analyzed through direct nursing care, interview and observation. The health problems identified included acute pain, high risk for infection, and anxiety. In order to properly relieve the pain of the patient, it is very important to teach the techniques of relaxing and to give analgesic by the order. The authors established a mutual trust relationship with the patient and educated her how to prevent from being infected, such as hand washing, wearing face masks in public, avoiding from eating raw food, and daily monitoring of body temperature. However, the post-transplant patient was worried about taking the immunosuppressant to rule for life. For the purpose of reducing patient’s anxiety, the authors arranged pharmacist to give medicine guidance, discussed the use of immunosuppressive agents, and requested the patient saying the use of medicines and function. Combined with other professional teams after kidney transplantation diet health education, the authors provide individual care to improve patient quality of life. In the recommendation of clinical care, we could provide the health care of kidney transplantation and the website related to immunosuppressant, add the standard of nursing care, make discharged service folder, and provide patient self-care knowledge and skills manuals. In order to enforce homecare, recipient and family can understand the instructions of post- operation and the importance of using medicines, which promote the integrity of discharge services.