照顧一位腎移植失敗面臨再次洗腎病人之護理經驗

本文主要描述照顧一位腎移植失敗，經醫療團隊評估後須再次血液透析的個案，個案因面臨再次洗腎衝擊而出現情緒激動、暴躁等反應，引發筆者關注，照護期間為2020年11月14日至2020年11月25日，護理過程中藉由觀察、身體評估、直接照護、病歷查閱及主動關懷等方式收集資料，依生理、心理、靈性及社會層面進行整體性評估，發現主要健康問題有：一、體液容積過量／與水份無法排出有關，二、潛在危險性感染／與長期使用免疫抑制劑有關，三、焦慮／與須再次進行血液透析有關。筆者於照護期間提供客製化水分控制方法，並以獎勵方式促進個案持續維持控制水分意願，修正其飲食習慣，並教導認識感染徵象及預防措施，期間主動聯繫醫療團隊各職類成員，發揮專長提供相關照護資訊，說明疾病治療方針以減輕焦慮，建議日後照護類似案例時，可由專屬個案管理師提供相關照護諮詢維持移植腎功能，並在病人面臨腎移植失敗時，需再次洗腎的心理建設，讓醫療團隊往後遇到類似案例時能有更好的因應之道。

This article recounts the experience of caring for a patient who experienced kidney transplant failure and was being evaluated by the medical team for a return to hemodialysis. The patient exhibited agitation and irritability in response to the prospect of resuming dialysis, prompting the author's attention. The care period for this patient extended from November 14, 2020, to November 25, 2020. Data collection during nursing care involved observation, direct care, physical examinations, medical record reviews, and proactive engagement. Through a comprehensive evaluation encompassing physiological, psychological, spiritual, and social dimensions, significant health problems were identified: 1. Hypervolemia due to the inability to excrete water, 2. Potential risk for infection associated with long-term immunosuppressant use, and 3. Anxiety related to the return to hemodialysis. Personalized interventions were implemented to address these issues. Techniques for hydration control were tailored to the patient's preferences, with a reward system employed to promote compliance. Dietary adjustments were made, and instructions were provided regarding infection signs and preventive measures. Proactive communication with various expert personnel within the medical team helped alleviate the patient's anxiety by offering comprehensive care information and explaining disease treatment plans. The article suggests designating a kidney transplant home nurse in future care scenarios to address patient inquiries and maintain transplanted kidney function, facilitating mental preparation for the possibility of dialysis treatment in the event of transplant failure. This proactive approach enhances the medical team's responsiveness to similar patients in the future.