一位腹膜透析病人成功轉為血液透析之護理經驗

Nursing Experience of A Peritoneal Dialysis Patient Successfully Converted to Hemodialysis

本文探討一位腹膜透析多年的女性，因腹內壓升高，導致左臀囊腫、左臀皮下組織滲液堆積及行動困難，面臨轉換血液透析治療之護理經驗。照護期間為2022年1月3日至2022年2月28日，筆者藉由身體評估、觀察、會談及病歷查閱等收集資料，運用Gordon十一項健康功能評估，分析整理，確認個案有調適障礙、潛在危險性感染及知識缺失等護理問題。運用同理心建立良好的醫病關係，提供個別的護理措施，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的改變；透析室屬於開放性空間，欲討論較心理層面問題時，擔心被別人聽到，會談中易有評估限制及中斷情形，建議透析室有獨立會談室，針對個案的需求，必要時可啟動跨團隊，共同面對與提供相關之措施，或是建置關懷模式，讓相同個案更能了解到轉變血液透析之必要性與重要性，也能建立更佳的護病關係，讓後續的照護更加順利。運用專業知識提供血液透析及血管通路照護，使個案提升自我照護能力及生活品質，冀望藉此成功轉換透析模式案例作為臨床人員照護之參考。

This article described the nursing care experience of shifting a long-term peritoneal dialysis female patient who suffered from increase in intra-abdominal pressure, the left hip cyst, the accumulation of exudate in the subcutaneous tissue of the left hip to regular hemodialysis. During the nursing period from January 3 to February 28 in 2022, we gather information by observation, conversation, and physical examination and use Gordon’s 11 multifunctional health scales to establish the nursing problems including mental problems and obstacles to social adjustment, risk for infection, and deficient knowledge. In order to overcame the obstacles of mental problems and obstacles to social adjustment, we not only use empathy to establish relationship with medical staff, but also cooperate with family members and kidney friends to give psychological support.
However, the hemodialysis unit is an open environment, which limited in-depth psychological discussions due to privacy concerns and the risk of being overheard. These fators pose challenges to effective psychosocial assessment and often result in frequent interruptions. To adress this, it is recommended that hemodialysis units provide access to a private counseling room. When appropriate, interdisciplinary colllaboration should also be initiated to address patients' needs and deliver comprehensive care. In addition, establishing a supportive care model may assist patients in similar situations to better understand the necessity and significance of transitioning to hemodialysis, thereby enhancing nurse-patient relationships and promoting smoother continuity of care.
We also educate the knowledge of hemodialysis and provides skills of vascular access care to improve their self-care ability and quality of life. We share the successful experience of shifting peritoneal dialysis to hemodialysis and wish to establish the model of shifting peritoneal dialysis to hemodialysis in the future.