照護一位末期腎臟疾病病人初次接受腹膜透析之護理經驗

Nursing Experience for an End-stage Renal Disease Patient Undergoing Initial Peritoneal Dialysis

本文是探討一位末期腎臟疾病病人初次接受腹膜透析之護理經驗。護理期間自2012 年1 月6 日至2 月2 日，運用Gordon 十一項功能性健康評估指引，經由觀察、會談、病歷查閱及理學檢查收集資料，確立護理問題為「體液容積過量」、「營養不均衡：少於身體需要」及「焦慮」。筆者教導病人觀察體液容積過量症狀、限制鈉鹽與鹽漬食物及計算合宜飲水量，有效減輕體液容積過量；並教導採取少量多餐、增添自然調味及維持口腔清潔以緩解噁心感，達到每日所需熱量，且適度補充蛋白質及富含鐵質的食物以改善貧血及低白蛋白血症之症狀；此外，運用關懷、傾聽及同理心等技巧，鼓勵病人表達焦慮感受，且使用衛教手冊、多媒體影片及實際示教腹膜透析技術，協助病人確認操作步驟的正確性與減緩焦慮程度。由電話諮詢及體重下降變化得知，此護理過程有效地增進病人居家腹膜透析的認知與技巧，展現自我照顧能力，故期此護理經驗能提供護理專業人員照護初次接受腹膜透析病人之參考。

This article described the nursing experience of caring for an end-stage renal disease patient undergoing initial peritoneal dialysis. The duration of nursing care lasted from January 6 to February 2, 2012. Gordon’s 11-item functional health assessment guidelines were used to collect data through observations, interviews, chart reviews and physical examinations. The patient’s problems were identified as excessive fluid volume, imbalanced nutrition--less than body requirements, and anxiety. The author educated the patient on the effective reduction of fluid overload by observing the symptoms of fluid overload, restricting the intake of salt and salted foods, and calculating the appropriate fluid intake. The author also taught the patient to eat small frequent meals, add natural seasonings, maintain oral hygiene to relieve nausea, follow the daily calorie requirement, as well as eat protein and iron rich foods to alleviate the symptoms of anemia and hypoalbuminemia. In addition, using the skills of caring, listening and empathy, the author encouraged the patient to express his feelings of anxiety. Furthermore, pamphlets, multimedia videos and the demonstration of peritoneal dialysis techniques were used to help the patient verify operational procedures and alleviate his anxiety. The nursing process effectively improved the patient’s knowledge and techniques in home peritoneal dialysis and enhanced self-care ability through telephone consultation and the changes in body-weight reduction. This nursing experience therefore provides a useful reference for nursing professionals taking care of patients undergoing initial peritoneal dialysis.