照顧一位末期腎病患者接受腎臟移植手術之護理經驗

The Experience of Nursing Care with an End-stage Renal Disease Patient Who Receives Kidney Transplant

本文探討一位末期腎病病人行腎臟移植手術之護理經驗，護理期間為2019年3月21日至2019年3月30日，藉由會談、身體評估、實際照護等方式，並利用Gordon十一項健康功能型態評估，確立護理問題包括焦慮、體液容積過量、高危險性感染。護理過程中針對護理問題擬定護理措施，因移植病人為感染高危險族群，教導其預防感染方法及持續監測傷口癒合狀況的重要性，因術後初期腎功能尚未完全恢復，導致無法完全排出水分、廢棄物及電解質，造成體內體液過量，進而引起周邊水腫，因此體重及輸出輸入量的監測也是評估的重點。對於術後返家自我照護，在住院期間利用移植手冊，提供移植術後自我照護相關訊息，進而減少病人的緊張情緒，例如：臨床護理人員可藉由治療過程中了解病人對藥物認識，及日常生活中應該注意的事項，並協助照會營養師、藥師及腎內衛教師，藉由跨領域團隊合作模式，與他們一同教導病人和家屬出院返家後日常生活中所需注意的細節，使其能早日恢復自我照顧能力，以提升術後居家生活品質。鑒於移植手術的特殊性，期望能夠藉由此護理經驗，提供更多臨床上照顧此類病患之參考。

This article discusses the experience of nursing care with an end-stage renal disease patient who receives kidney transplant. Nursing period was from March 21st to March 30th, 2019. The nursing problems were evaluated by Gordon 11 Function Health Patterns and established as anxiety, excess fluid volume and high risk for infection after a serial of conversation, physical examination and practical care. To deliver proper nursing measures for nursing problems in the progress, since organ transplant recipients are in high-risk group of infection, we emphasized on the importance of infection avoidance and continuous wound condition tracking in our teaching. Body weight and intake/output monitoring were also one of evaluation points because renal function was not fully recovered at that time. During early postoperative period, body couldn't fully excrete moisture, wastes, and electrolytes, causing body fluid excess and afterward the peripheral edema. As to self-care after discharge, we used the manual of kidney transplant to provide some self-care knowledge after transplantation during hospitalization. This also helped to ease patient's tension. For example, clinical nurses can understand how much the patients know about drugs they are using and what they should notice in daily life during treatment. Then, nurses assist dietitians, pharmacists and chronic kidney disease educators as interprofessional collaboration to teach patients and their family about the details they should pay attention to in daily life. This can encourage them to restore self-care ability as soon as possible to improve the life-quality after discharge. Due to the particularity of transplant surgery, we share this nursing experience in hope of providing more reference for similar clinical caring cases.