一位接受腹膜透析個案疲憊之護理經驗

The Nursing Experience of an ESRD Patient Undergoing Peritoneal Dialysis Patient with Fatigue

本文主描述一位66歲女性個案，因罹患高血壓、糖尿病合併末期腎病變接受腹膜透析治療之護理經驗。護理期間為2011年6月20日至7月11日，藉由直接照顧、觀察、身體評估及深度訪談等方式收集資料，運用Orem自我照顧理論為評估架構，分析並歸納出個案有潛在危險性感染、疲憊及知識缺失等健康問題。經由主動傾聽及有效的溝通瞭解個案的需求，建立信任的護病關係，給予完全代償、部分代償性及支持性與衛教性護理措施，協助修正生活習慣。治療中提供適切的護理措施，引導個案及家人參與並學會導管出口照護以預防感染發生；利用腹膜透析之教學影片及實物模型，增加透析治療的相關知識及居家自我照顧注意事項，能正確且完整的操作腹膜透析換液技術；加強個案對疲憊感的認知和自我察覺能力，擬訂循序漸進的運動計劃以減輕疲憊感；利用正向回饋促進學習動機，增強自我照顧意願及技巧，將治療整合到日常生活中，讓個案及家人可以勇於面對未來腹膜透析的生活，更增加家人間的互動與扶持。期望藉此個案的護理經驗，提供護理人員日後臨床照護之參考。

This article described the nursing experience for a 66-year-old patient with diabetic-related end-stage renal disease (ESRD) undergoing peritoneal dialysis complicated with severe fatigue. The nursing period was from June 20, 2011 to July 11, 2011. By direct care, observation, physical assessment, and in-depth interview with this patient, after analyzing the data based on Orem’s self-care theory, we concluded that the healthy problems for this patient consist of risk of infection, fatigue, and a lack of knowledge. During the nursing period, we communicated with this patient actively and listened to this patient to build up mutual trust. Through partly and fully compensatory and supportive and educative nursing procedures, we helped correct the bad habits and lead this patient and families to participate and learn how to care the catheter opening to prevent infection. By the teaching video and object model, we increased this patient’s peritoneal dialysis-related knowledge and home-care ability. In addition, we also strengthened this patient’s perception of fatigue and self-awareness. To alleviate fatigue, we set up progressive exercise plan. By application of positive feedback, we stimulated this patient’s learning motive and, subsequently, increase his self-care willingness and ability. We integrated the medical treatment into this patient’s daily life, which made this patient and the families face the future bravely and increased the interactions among them. The report provides a useful nursing experience to the nursing staff taking care of the similar patients.