一位青年接受初次血液透析調適障礙之護理經驗

The Nursing Experience of Caring a Youth Receiving the First Hemodialysis Adjustment Disorder

本文描述一位初診斷末期腎病之21歲男大生，由於須長期透析，對疾病不了解，難以接受罹病事實產生調適障礙之護理經驗。照護期間為2020年2月3日~2020年2月21日，以身體評估、會談、觀察及查閱病歷並運用羅氏適應理論評估收集資料，歸納有：體液容積過量、知識缺失、調適障礙等三項健康問題。針對體液容積過量、知識缺失問題，照護期間結合智慧手機應用程式提供飲食衛教，利用多媒體光碟影像教學及回覆示教，有效改善了體液過量引發的不適，並增加自我照顧能力。在調適障礙上：與心理諮商師合作，藉由主動關懷、鼓勵說出內心感受、傾聽及同理、澄清錯誤認知、增強家庭支持、共同決策治療方向與年輕腎友經驗交流，增加了自信心、希望感、找回同儕團體歸屬感，產生正向心理調適及生活適應；然而個案回歸學校後，落實持續自我健康管理之困難實非易事，建議個案管理師收案出院前提醒個案應定期回門診追蹤，討論腎臟移植之可能，促使個案獲得更完整的後續照顧。分享此一歷程，期望能作為未來護理相似個案之參考。

This paper describes the nursing experience of caring for a 21-year-old male student diagnosed with end-stage renal disease. Due to the necessity of long-term dialysis and difficulty accepting his diagnosis, the patient developed an adjustment disorder. The nursing care period lasted from February 3 to February 21, 2020. Through physical evaluations, meetings, observations, and medical record reviews, three primary health problems were identified by applying Roche's adaptation theory for data collection: excessive body fluid volume, lack of knowledge, and adjustment disorder. To address these issues, care included food hygiene education supported by smartphone applications, multimedia CD-ROMs, and interactive teaching methods. These interventions effectively alleviated discomfort from excess fluid and improved the patient's self-care capabilities. For the adjustment disorder, collaboration with psychological counselors helped enhance the patient's self-confidence, sense of hope, and belonging to peer groups. Active care strategies, such as encouraging the expression of feelings, listening with empathy, clarifying misconceptions, enhancing family support, and involving the patient in treatment decisions, facilitated positive psychological adjustment and life adaptation. Interaction with other young kidney patients also provided valuable support. However, upon returning to school, the patient faced challenges in maintaining continuous self-health management. Overall, it is recommended that case managers remind patients to attend regular follow-up clinics and discuss the potential for kidney transplantation to ensure comprehensive ongoing care for the patient. Sharing this experience aims to serve as a reference for managing similar nursing cases in the future.