一位高齡血液透析合併膝關節置換喪偶患者之護理經驗

A Nursing Care Experience of an Elderly Dialysis Patient with Knee Replacement and the Death of the Spouse

本文描述高齡血液透析合併膝關節置換喪偶患者的護理經驗。護理期間自2018年10月4日至10月20日，運用Gordon十一項健康功能型態評估，藉由會談、傾聽、觀察及直接照護方式收集資料，確立有無效性健康維護能力、營養不均衡：少於身體所需、哀傷等健康問題。首先與個案建立良好護病關係，教導採取舒適臥位、冰敷及抬高患肢、止痛藥物治療，有效緩解疼痛；予術後傷口照護，進行回覆示教，避免傷口感染；教導術後復健活動，盡速恢復活動功能；教導高蛋白飲食及基本熱量攝取量，改善營養不良；藉由充分心理支持與陪伴，協助有效地進行時間調適生活，成功渡過喪偶歷程。建議成立全人跨團隊關懷成員，以提升照護品質。

This article describes the nursing care experience of an elderly dialysis patient with knee replacement after losing his wife. The period of nursing care was from October 4 to October 20, 2018. Gordon’s 11 functional health assessment guide employs interviewing, listening, observation, and care to assess the nursing problem. The nursing diagnosis included ineffective health maintenance, imbalanced nutrition less than body requirements, and grief. First, the nursing interventions included establishing a good nurse-patient relationship, educating this patient to elevate the surgery extremity, and analgesics medication to improve pain. We also provided postoperative wound care, and rehearsal of wound care skills to avoid wound infection. He was taught about a high-protein diet and basic calorie intake to improve malnutrition. Adequate psychological support and companionship were given to effectively adjust to this time of his life and successfully pass into widowhood. We established a holistic care member to improve the quality of care.