一位移植腎衰竭病人再次接受血液透析治療之護理經驗

Nursing Experience: A Patient Returning to Hemodialysis due to Renal Failure after Kidney Transplantation

本文為描述一位末期腎病變個案接受腎臟移植五年後，因移植腎衰竭再次接受血液透析治療之護理經驗。護理期間自2014年1月16日至2014年3月20日，筆者運用Gordon十一項功能性健康型態評估作為指引，與個案建立良好護病關係，透過身體評估、觀察、會談及個案生活記錄本等方式收集資料並加以分析，確立主要護理問題為：體液容積過量、知識缺失、無望感、潛在危險性感染。在照護過程中，以個人飲食日記檢視及修正飲食習慣，教導正確飲食及服藥方式的健康行為，使其能有效執行水分控制與改善血清磷過高狀態，運用護理措施教導用藥、飲食及動靜脈瘻管傷口相關照護預防感染，在心理上以傾聽、陪伴、介紹二次移植腎友的成功經驗激勵對未來抱持希望，助其積極面對再次進入透析生涯，重新規劃未來生活的藍圖，期望本文的經驗分享，能提供同儕做為照護此類病人之參考。

This article described the nursing experience of an ESRD case who received a kidney transplant five years ago but was resuming hemodialysis treatment again after the failure of the renal transplant. For the period of patient hemodialysis lasting from January 16 through to March 20, 2014, the author verified through physical assessment, observation, interviews and Gordon’s Functional Health Patterns that the patient had the following problems: fluid overload, lack of adequate knowledge, risk of infection, and hopelessness. Nursing intervention during the care period taught the patient the following: medication, diet and wound care for arteriovenous fistulas to prevent infection; keeping a diet diary to review and maintain a proper diet for effective water control and preventing hyperphosphatemia; improving the patient’s psychological shape through listening, companionship, and introduction of successful secondary transplant cases to build up hope for the future, help them face living with dialysis again, and draw up new plans for the future. Experience shared in this article will hopefully provide peers with a useful reference in caring for such patients in the future.