一位年輕女性狼瘡腎炎初次血液透析之護理經驗

A nursing Experience of a Young Women with Lupus Nephritis Undergoing Hemodialysis for the First Time

紅斑性狼瘡是自體免疫疾病，侵犯全身器官產生炎症反應，造成器官損傷，若狼瘡腎炎併發肺水腫亦增加疾病的嚴重度。本文敘述一位30歲年輕女性患紅斑性狼瘡長達13年，因雙下肢嚴重水腫合併呼吸窘迫緊急血液透析治療，產生了極大壓力而出現不安、害怕及哀傷情緒反應。護理期間自2014年1月25日至2014年3月30日，運用Gordon十一項健康評估，以會談、觀察、身體評估、病歷查閱等方式收集資料，確認個案主要健康問題：體液容積過量、潛在危險性感染及預期性哀傷。藉由主動關懷、同理心等支持技巧與個案建立良好護病關係，運用個別性護理措施及專業知識，製作血液透析日常生活自我照護手冊，積極與醫療團隊溝通，提升個案對血液透析認知及導管留置問題之照護技巧，讓個案正確執行日常生活自我照護及預防感染之事項；心理社會層面主動關懷個案需求，鼓勵表達內心感受並透過腎友團體協助正向面對疾病造成身體心像之改變，建構出新的自我價值，正向調適面對長期血液透析。期望此護理經驗可提供臨床相關人員，在照護初次接受血液透析病人之參考。

Systemic lupus erythematosus (SLE) is an autoimmune disease that harms all of the bodily organs through inflammatory reaction. When lupus nephritis is complicated by pulmonary edema then patient mortality is increased. In this article, we describe and share the nursing experience for a 30-year-old women with SLE for over 13 years who presented with bilateral legs edema, respiratory distress as well as feelings of unease, fear and grief from extreme stress. Between January 25, 2014 and March 30, 2014, we used Gordon’s 11 Functional Health Patterns to evaluate this patient through interviews, observations, physical assessment, medical records and other methods of data collection. We also confirmed major health problems such as excess fluid volume, risk of infection and anticipatory grief. Through proactive concern, empathy and other support skills, we established a good nurse-patient relationship. We used individualized nursing expertise to produce a hemodialysis everyday self-care manual. By actively communicating with the medical care team, the patients understanding of hemodialysis and catheter care was enhanced. We eventually enabled the patient to take proper care of herself in daily life and prevented catheter-related infection. On the psychosocial level, we use active expressions of concern to encourage the patient to express her feelings. With the assistance of the hemodialysis support group, we helped her adopt a positive attitude to the physical and mental effects of her disease. Finally, we helped her to rebuild her self-esteem and come to terms with long-term hemodialysis. We hope this clinical nursing experience will provide a useful reference for personnel involved in clinical practice during the initial care of patients undergoing time hemodialysis for the first time.