照顧一位血液透析合併大腸癌個案的護理經驗

Nursing Experience in Caring for a Hemodialysis Patient with Colorectal Cancer

本文探討一位腹膜透析後因腹膜清除率下降轉以血液透析，卻同時又罹患大腸癌個案的照護經驗，面對兩種重大疾病的衝擊，從一開始對治療採取消極、逃避的態度，筆者運用實證護理及另類療法等文獻整理出具體的護理計畫，幫助個案減輕血液透析治療時瘻管穿刺的疼痛及壓力，能以平靜的心情面對罹癌生活。護理期間為2020年3月1日至2020年4月30日，以觀察、會談、傾聽、身體評估、病歷查詢、理學檢查等方式收集資料，並進行生理、心理、社會及靈性層面等四個層面的整體性評估，確立主要的健康問題為體液容積過量/與攝入過多液體及腎臟調節機轉功能失調有關、焦慮/與害怕瘻管穿刺疼痛有關、無望感/與身體疾病有關。在照護過程增加水分控制的相關知識，矯正個案對液體需求的錯誤觀念；提供全人關懷及適切的透析照護措施降低個案的疼痛焦慮感；以關懷、傾聽、同理、鼓勵及支持之溝通技巧，協助其以正向的態度面對治療，改善無望感，在心理及靈性上也可得到安適，減少沮喪與哀傷。期望藉此護理經驗，提供護理人員在照顧類似個案時能發揮護理獨特性及專業自主性，發展更適切的照護措施以提高護理品質。

 

Summary

This article discusses the case of a patient who needed to relieve the pressure of hemodialysis treatment and live with a positive attitude with his colorectal cancer. During the period of 1 March 2020 to 30 April 2020, data was collected through observation, interview, listening, physical assessment, medical record inquiry, and physical examination, and a four-level holistic approach was carried out at the physical, psychological, social, and spiritual level. It was assessed that the main health problems were excess fluid volume/related to excessive fluid intake and dysfunction of renal regulation, anxiety related to fear of fistula puncture pain, and hopelessness related to physical illness. We aim to increase knowledge about fluid control in the care process, correct misconceptions about fluid requirements, provide holistic care and appropriate dialysis care measures to reduce pain and anxiety, and use caring, listening, empathy, encouragement, and supportive communication skills to help patients face treatment with a positive attitude, improve feelings of hopelessness, and reduce depression and grief by providing psychological and spiritual comfort. We hope that this nursing experience will provide nursing staff with the opportunity to bring out the uniqueness and professional autonomy in caring for similar cases and to develop more appropriate care measures to improve the quality of care.