協助一位移植後腎衰竭社交隔離患者回歸社會之護理經驗

Nursing Experience in Assisting a Socially Isolated Patient with Renal Failure after Renal Transplant to Reintegrate into Society

本文在探討一位36 歲女性糖尿病末期腎病變病人，於腎臟移植六年後，因對於自我健康照護不足，以致需再度接受血液透析治療的護理經驗。護理期間自2016年04 月1 日至2016 年05 月22 日，於病人每星期固定到院透析期間，運用歐倫（Orem）護理理論評估作為指引，運用身體評估、觀察、訪談及病人自主紀錄手冊等方式收集資料並分析數據後，確立主要護理問題為：體液容積過多、知識缺失及社交隔離。在照護過程中，透過護理專業及協同各醫療團隊合作下，檢視病人日常飲食紀錄及習慣後，運用護理措施教導用藥、飲食相關照護，教導正確日常飲食方式，導正病人飲食及用藥習慣的健康行為，使其能自主有效執行水分控制與改善血磷過高的狀態；在心理上則鼓勵表達出心中擔心的事情及感受，利用院內及家中的支持系統，鼓勵參與各項活動，以提高病人自我價值感及擴展社交圈，助其重新走入人群，正向積極去面對再次進入透析生活，等待下次換腎機會。

 

This article explores the case of a 36-year-old woman with end-stage diabetic nephropathy who, after six years of receiving kidney transplantation, is in need of for hemodialysis again due to inadequate self-health care. The nursing period was from April 1 to May 22, 2016, when the patient had weekly dialysis at the hospital. Orem nursing theory was used as assessment guideline, after collecting and analyzing the data through physical assessment, observation, interviews and patient records, the main nursing problems were confirmed to be: excessive body fluid volume, lack of knowledge and social isolation. In the care process, through the nursing professionals and the collaboration of the medical teams, after reviewing the patient’s daily diet records and habits, used nursing measures to teach the patient about proper medication taking and healthy eating, guided her to establish a healthy daily eating and medicating routine that would enable the patient to independently implement liquid intake control and prevent hyperphosphatemia; psychologically, encouraged her to express her feelings and worries, use the support system in the hospital and at home, encouraged her to take part in activities to improve self-worth and expand her social circle, leading her to live positively with dialysis while waiting for the opportunity of a new kidney transplant.