一位末期腎病患面臨透析治療之護理經驗

Care Experience with an End-stage Renal Failure Patient During Dialysis Treatments

本個案報告乃探討一位末期腎病患初面臨血液透析及連續可活動性腹膜透析之生理及心理衝擊，筆者於個案住院、返院透析期間及家訪，以身體檢查、觀察及會談所得資料，歸納出個案有體液容積過量、抉擇衝突、高危險性感染、疲憊及低自尊等健康問題。透過相關訊息提供來解決體液容積過量:了解個案對治療型態所關注層面，透過共同討論及病友經驗分享來幫助面臨抉擇；教導透析技術之正確操作方法與居家環境的佈置來預防感染；並與個案訂定運動計畫來減輕其疲憊感；利用放鬆技巧及正向迴饋以促進其學習技術，運用傾聽及引導生命回顧來維持自尊，進而增進個案自我照顧的能力及協助早日回歸社會。

The case report presents an end-stage renal disease patient who experienced the hemodialysis and continous ambulatory peritoneal dialysis treatment in physiological and psychological impacts. The author tried to correct data by physical examination, observation and interview when the patient was admitted, returned to hospital for dialysis and home visit. The results showed that the client had fluid volume excess, decisional conflict, high risk for infection, fatigue and low self-esteem. We are providing information to improve fluid volume excess, understanding patient's concern domains and discuss with peers to help decision making, educating peritoneal dialysis skills and home environmental preparation to avoid infection, following exercise training to decrease fatigue, using relax skills and positive feedback to enhance learning, and by listening and lifetime looking backward to keep self-esteem so as to promote self-care abilities and reward to society.