照顧一位克服對血液透析焦慮個案之護理經驗

A Nursing Experience of Taking Care of Patient to Overcome the Anxiety for Hemodialysis

本文是描述一位接受血液透析數次後對透析產生害怕而自行中止治療，而後因呼吸喘才又無奈的再次接受透析個案之護理經驗。護理期間自2012年2月11日至4月12日，經由身體評估、觀察及會談技巧收集資料，運用羅氏適應模式進行護理評估，確立個案有：噁心、潛在危險性感染、知識缺失、焦慮等護理問題。筆者在護理過程中以主動關懷的方式提供血液透析相關知識，矯正個案對營養需求錯誤觀念，進一步加強其對高蛋白飲食的認知及導管留置問題的照護技巧，讓個案能正確攝取營養及執行預防感染之事項，並透過音樂治療的介入，來減輕害怕使其坦然面對透析治療，以達到良好的適應。期望藉此護理經驗提供血液透析護理人員做為臨床照護之參考。

This article describes the nursing experience of a patient who terminated hemodialysis treatment due to fears after receiving multiple dialyses. Later, the patient was taken in for dialysis again because of worsening asthma condition. The nursing period was from the 11th of February, 2012 to the 2nd of April, 2012. The author collected the information through physical assessment, observation, and interviews with the patient. Nursing assessments was performed by means of Roy Adaptation Model. It is concluded that the patient has problems of nausea, potential risk for infection, lack of knowledge, and anxiety. Nursing cares included provision of relevant education for hemodialysis and ramification of concept about intakes of nutrients. Furthermore, we strengthened patient’s awareness for high protein diet and improved the skills for catheter care which ensured the patient maintain sufficient nutrients and reduced the risk of infection. Through the intervention of music therapy, the patient’s fears were alleviated. It is hoped that this nursing experience can provide the hemodialysis nurses with a reference for clinical care.