照護一位營養不良合併不寧腿症候群之血液透析病患的護理經驗

Care for a Hemodialysis Patient Experiencing Malnutrition with Restless Leg Syndrome: A Case Report

居家照護及營養攝取對血液透析病患及家屬是一個生活上的挑戰，臨床上更發現透析病人合併不寧腿症候群的發生率有逐漸攀升趨勢，直接衝擊病患情緒、精神狀況並影響其生活品質與適應狀況，但透析中心護理人員卻極少提供病患相關疾病及自我照護資訊。此個案報告分享一位營養不良合併不寧腿症候群之血液透析病患照護經驗，期望提供臨床護理人員對不寧腿症候群有更多的認識及相關的護理措施。本文運用羅氏適應模式協助並增長一位61歲血液透析並罹患不寧腿症候群病患的充能及調適過程。照護期間經由會談、身體評估、查閱病歷等方式收集資料，評估個案的護理問題有（一）營養少於身體所需（二）焦慮（三）睡眠型態改變。護理過程中運用傾聽，了解個案對營養不良合併不寧腿症候群的血液透析負向感受，提供正向支持系統，並運用護理專業知識，提供血液透析相關知識、腎友的經驗分享、衛教含鐵食物及自我照顧技巧等措施。個案透過適切的護理照護措施及衛教，逐步的適應血液透析的生活，學習不寧腿症候群的居家照護方式，提高其生活的滿意度。

Home care and nutrition are everyday challenges for hemodialysis patients and their families. Clinical research has found an increase in the incidence of restless leg syndrome with hemodialysis which affected patients’ emotions, mental state and quality of life. Nurses in the dialysis center however rarely give patients information on the disease and self-care. This study presents the clinical nursing experience with a 61 year-old hemodialysis patient experiencing malnutrition with restless leg syndrome, using Roy’s adaptation model to assist with and enhance the patient’s empowerment and adaptation, and to provide clinical nurses with more information and nursing interventions related to restless leg syndrome. The data for the case report was collected through consultation, physical assessment, review of patient records, and physical examination. The health problems were as follows: (1) nutrition less than body requirements, (2) anxiety, and (3) sleep pattern disturbance. During the nursing process, the researcher used empathy skills to understand the negative perception of the hemodialysis patient with malnutrition and restless leg syndrome. The researcher provided a positive support system to the patient and used professional nursing knowledge to impart related knowledge and suggestions concerning diet therapy and self-care skills. Through these nursing interventions and health education, the patient gradually adapted to hemodialysis treatment, learned about home care for restless leg syndrome, and improved his satisfaction with life.