照顧一位血液透析孕婦之護理經驗

Pregnancy in a Female Patient under Hemodialysis

接受血液透析治療後要懷孕是一件不容易的事，此個案為本透析中心第一位接受血液透析時懷孕之病例，筆著於2012/4/2 至2012/8/3 藉由觀察、會談、身體評估、臨床每月檢驗數據及透析紀錄來收集相關資料，應用Gordon 十一項健康型態進行整體性評估，發現個案有血色素過低、抉擇衝突、焦慮的問題。護理過程中筆者運用同理心、陪伴、傾聽、了解個案家庭面對決定生產之衝突，經由團隊的整體性評估與監測，透析過程確保孕婦胎兒之安全，並讓個案及案夫能正向面對決定，積極配合醫療處置。此外，亦提供相關醫療資訊、衛教提升血色素之飲食、增加EPO 使用量來改善貧血問題，且解決個案疑慮，減輕其內心之擔憂，與其共度懷孕期，並最後順利產下一名健康女嬰。建議辦理交叉訓練、增設透析懷孕個案照護流程紀錄表單，以便同仁遇到此類個案時溝通協調，期望藉由護理經驗分享，提供相關護理人員照護類似個案時之參考。

It’s not easy for a patient with end stage renal disease to get pregnant. Here we report on a patient who became pregnant while on maintenance hemodialysis. The authors collected relevant information by observation, counselling, and physical evaluation from April 2nd, 2012 through to August 3rd, 2012. By means of Gordon’s 11 functional health patterns, we found that the patient was experiencing low hemoglobin level, conflicts over choices, and anxiety. The author utilized the skills of sympathy, companionship, and listening to understand the difficulties faced by the subject. Comprehensive evaluation, monitoring and management ensured the safety of the fetus during dialysis procedure. In addition, the team minimized potential harm to the patient and her husband by means of positive thinking and decision-making. Diet education and increased use of EPO produced an improvement in anemia. The author also provided relevant information to relieve patient anxiety. The patient eventually gave birth to a healthy baby with no complications. We recommend training programs as well as keeping flow charts and records for pregnant patients under maintenance dialysis for future reference and mutual communication among staff. In sharing this case, the author hopes to help nursing personnel with caring for patients in similar situations in the future.