一位自腹膜透析轉換成血液透析病人之護理經驗

The Nursing Experience of a Patient Switching from Peritoneal Dialysis to Hemodialysis

本文在探討一位因妊娠毒血症引起末期腎臟病病人，由於工作環境悶熱易口渴常不自覺攝取過多開水，導致長期無法有效控制水份，而必須由腹膜透析轉換成血液透析治療所面臨的生理及心理問題之護理經驗，護理期間為101 年07 月23 日至101 年10 月22 日，筆者運用羅氏適應模式護理評估架構，藉由觀察、會談、身體評估及病歷查閱等方式收集資料，分析後發現病人有：體液容積過量、健康維護能力改變及調適障礙三個護理問題。在護理過程中，筆者與病人建立良好的治療性關係，並運用主動關懷、支持、接受及同理心技巧鼓勵病人表達心中的想法及擔憂，且依據其需求與病人及家人共同擬訂個別性的護理措施，提供正確的動靜脈瘻管自我照護技巧及有效的水份控制方法，協助病人順利適應生理及心理問題，使病人能正向且積極的面對腹膜透析轉換成血液透析治療的過程，並能與家人重新規劃未來的生活，提升生活品質。

This paper describes a physical and mental nursing experience of a patient with pre-eclampsia caused by end-stage renal disease who had to switch from peritoneal dialysis to hemodialysis due to ineffective water control over a long period of time stemming from a humid working environment, thirst, and excessive liquid intake. The nursing care period was from July 23, 2012 to October 22, 2012. The author adopted Roy’s adaptation model to evaluate the data collected from observations, interviews, physical examinations and chart reading. The three nursing care issues identified including fluid overload, changes in health maintenance, and difficulties in adjustment. During the nursing care process, the author established a positive therapeutic relationship with the patient. Proactive care, support, acceptance, and empathy techniques were adopted to encourage the patient to express her opinions and worries, followed by teaming up with the patient and the family to set up nursing strategies personalized to the patient’s condition. Correct information on self-care of arteriovenous fistula and effective water intake control was also provided. After the patient was given assistance with physically and mentally adjusting from peritoneal dialysis to hemodialysis, she was able to come to terms with the change, start planning for a new life with her family and make efforts to improve her quality of life.