一位因廓清不足增加血液透析病人照護經驗

A Patient with Increased Experience in Caring for Hemodialysis Patients Due to Insufficient Clearance

本文敘述一位長期腹膜透析個案因透析廓清不足需要接受血液透析治療而影響個案的身、心健康之護理經驗。護理照護期間為2023年3月6日至2023年5月20日，筆者以病歷查閱、溝通、觀察、傾聽、身體評估等評估方法及利用電訪問收集相關資料，並依生理、心理、靈性及社會層面進行整體性評估，分析整理，發現個案面臨透析模式和生活型態的改變，與血液透析及相關照護的不了解引發之生、心理改變，發現個案之健康問題有：體液容積過量、知識缺失/缺乏血液透析治療相關居家飲食控制自我照護資訊、調適障礙/與透析治療模式改變有關。經由陪伴與傾聽等照護措施，建立彼此信任關係及運用專業知識提供相關照護指導，翻轉其負面想法，與病人共同擬定照護計劃，自我監測血壓、體重變化，教導放鬆技巧以降低不安、無助、焦慮、沮喪情緒，並藉由醫護人員、家人及腎友心理支持、關懷力量，使個案能正向面對透析模式。腹膜透析併作血液透析治療可預防透析病人發生腹膜硬化症，也可改善病人生理不適如貧血、降低鐵蛋白、與高血磷等，保留腹膜功能以減少高濃度透析藥水使用，主動關懷個案讓其接受增加血液透析治療，筆者藉此經驗分享給相關透析醫護人員，做為日後病人照護指引，提高病人整體醫療品質滿意度。

This article describes the nursing experience of a long-term peritoneal dialysis patient who required hemodialysis treatment due to insufficient clearance, which affected the patient's physical and mental health. The nursing care period is from March 6, 2023 to May 31, 2023. The author collected data through physical assessment, observation, interviews, and medical record review, and used Gordon's eleven health function assessments to analyze and organize. The author found that the cases faced changes in dialysis mode and lifestyle, and the lack of understanding of hemodialysis and vascular access care caused physical and psychological changes. The author confirmed that the main health problems of the case were: excessive body fluid volume, lack of knowledge/ lack of home dietary control self-care information related to hemodialysis treatment, and adjustment barriers/related to changes in dialysis treatment models. Establish a nursing relationship with the patient through companionship and listening. Use professional knowledge to provide hemodialysis and vascular access care, integrating relevant literature and providing based on the content of the literature. Through the psychological support and caring power of medical staff, family members and patients, patients can face the dialysis model positively. We hope that this experience can be used as a reference for clinical care.