協助一位腹膜透析患者接受腹腔鏡手術之護理經驗

Nursing Experience of a Patient with Peritoneal Dialysis Receiving Laparoscopic Surgery

本個案報告描述照顧一位因膽結石接受腹腔鏡膽囊切除手術之腹膜透析患者之護理經驗。護理期間為2013年1月6日至2013年1月18日，經外科醫師評估，建議個案術後暫時轉血液透析，但個案拒絕，筆者運用Gordon十一項功能性健康型態進行整體評估，並藉由觀察、會談及身體評估方式收集資料，確立個案的護理問題為潛在危險性感染、焦慮及營養不均衡：少於身體所需。筆者於護理過程中運用跨團隊整合性照護，主動持續關懷、傾聽個案需求、鼓勵說出內心感受，以及尊重個案不願意轉血液透析的想法，藉由腹部模型教具，採示教、回覆示教方式指導主要照顧者換液技巧，預防透析過程中發生感染；協助個案降低對血性透析液之恐懼與焦慮；會診營養師共同訂定個別性照護計畫，調整營養失衡的情況。經由以上照護，個案於出院時無感染情形發生，且營養問題獲得改善，在家人的陪伴下，重建自我照顧能力，提升其生活品質。故在此建議落實不同透析模式衛教，增進照顧者認知及照護能力，使個案能得到持續性、完整性之照護品質。

This study described the experience of nursing a peritoneal dialysis patient who received laparoscopic cholecystectomy for gallstones. The period of nursing care began on January 6, 2013, and ended on January 18 of the same year. Based on the surgeons’ evaluations, temporary post-surgical hemodialysis was recommended but this was rejected by the patient. The study was conducted using Gordon’s 11 Functional Health Patterns and the data were collected through observations, interviews, as well as physical assessments. The patient’s nursing care problems were confirmed to include potentially dangerous infections, anxiety, and imbalanced nutrition (less than the body’s requirement). During the nursing care process, a multi-disciplinary care strategy was implemented where the care staff actively responded to the patient’s demands, encouraged her to express internal feelings, and respected her decision to refuse hemodialysis. With the use of abdominal models, the patient’s primary caretaker was taught through the demonstration and repetition method on how to perform fluid exchanges to prevent infections during the dialysis process, as well as help minimize the patient’s fear and anxiety towards hemodialysis. In consultation with dieticians, personalized care plans were co-developed to correct the problem of imbalanced nutrition. Through the above care strategies, the patient did not suffer from infections when she left the hospital, and the problem of imbalanced nutrition saw improvement as well. With the family’s support, the patient was able to re-establish self-care capabilities and achieve improved quality of life. A thorough implementation of health education on different types of dialysis is therefore recommended to enhance the caretaker’s knowledge and care-giving abilities as this will ensure that the patient receives continuous and comprehensive care.