照護一位長期血液透析病患中風後之護理經驗

Nursing Experience with a Long-term Hemodialysis Patient After Stroke

本文為敘述照護一位長期血液透析病患罹患腦中風後面臨肢體活動障礙及心理調適之護理經驗。筆者於2012年9月26日至2012年12月31日護理期間，利用Gordon十一項健康功能型態做為評估架構，並以溝通、觀察、會談及傾聽等技巧收集資料，歸納出個案有營養狀況改變-磷多於身體需要／與飲食控制差有關，自我照顧能力缺失／與疾病導致神經功能受損右側肢體無力有關，跌倒／與疾病併發症導致右側肢體無力有關，無力感／與對日常生活控制力減低有關等護理問題。筆者藉由與個案及家屬建立良好互動，提供相關疾病知識，鼓勵積極配合復健治療，並施予個案及家屬具個別性之護理活動，加強個案自我照顧能力，以預防跌倒事件發生。另一方面主動關懷並陪伴個案，鼓勵個案及家屬表達內心感受及無力感，增進家人間的互動，持續給予正向支持與回饋，協助個案能適應其生活型態的轉變，更有信心面對未來，進而維持優良透析生活品質。

This article describes nursing experience with a long-term hemodialysis patient facing physical handicaps and psychological adjustment after stroke. During the nursing period from September 26, 2012 to December 31, 2012, the author used Gordon’s eleven functional health patterns as the assessment framework, and collected data using communication, observation, interview and listening techniques. Conclusions included: change in nutritious status and hyperphophatemia related to poor diet control; impairment of self-care ability related to neurological dysfunction and right side limb weakness; falling related to right side limb weakness due to complications; and powerlessness related to reduced control over daily life. By establishing good interactions with the patient and family, the author and provided knowledge related to the disease and encouraged cooperation with physiotherapy. Personalized nursing care activities were also arranged for the patient and family to enhance self-care ability and prevent falling. At the same time, proactive caring and companionship for the patient and family members encouraged them to express of their feelings and sense of helplessness. We also enhanced co-operation between patient and family, continued to give positive feedback and support, helped the patient adapt to lifestyle changes so that he could to face the future with greater confidence. This in turn enabled him to maintain good quality of life with dialysis.