照顧一位腹膜透析併發橫膈疝氣病人之護理經驗

Nursing Experience of Caring for a Patient Undergoing Peritoneal Dialysis with Comorbid Diaphragmatic Hernia

本文描述一位52歲接受腹膜透析1年之女性，因併發橫膈疝氣，引發身心不適的護理經驗。護理期間2016年3月5日至3月16日，筆者運用Gordon十一項健康功能型態評估為指引，藉由會談、觀察、身體評估及查閱病歷等方式收集資料，發現個案有低效性呼吸型態、急性疼痛、焦慮等健康問題。於照護期間，主動持續關懷、傾聽個案需求、鼓勵說出內心感受，以及尊重個案不願意轉血液透析的想法，提供個別性護理協助緩解其生理不適，教導深呼吸、放鬆技巧及肢體按摩以減輕舒緩術後傷口疼痛；而針對術前的焦慮積極與醫療團隊討論，提供相關資訊及護理指導，澄清相關疑慮，並藉由家人陪伴及腎友經驗分享，提供正向鼓勵與支持，降低焦慮感，改善身心不適症狀，幫助個案穩定持續性的腹膜透析，達到最佳的生活品質。希望藉此照護經驗，提供臨床護理人員日後照護相關個案之參考。 This paper describes the nursing experience of caring for a 52-year-old female patient who underwent peritoneal dialysis for a year and experienced physical and mental discomfort due to comorbid diaphragmatic hernia. The care period was from March 5 to 16, 2016. The authors used Gordon’s 11 Functional Health Patterns as a guide and conducted interviews, observations, and a physical assessment and examined her medical records to collect information. We found that the patient had an ineffective breathing pattern, acute pain, anxiety, and other health problems. During the care period, we proactively showed concern, listened to her needs, encouraged the patient to verbalize her innermost thoughts, and respected her views about not converting to hemodialysis. We provided personalized nursing aid to alleviate her physiological discomfort, taught her deep breathing, relaxation techniques, and limb massage to alleviate postoperative wound pain. We also proactively discussed her preoperative anxiety with the medical team, provided relevant information and nursing guidance, and cleared pertinent doubts. In addition, the companionship of her relatives and shared experiences with other dialysis patients provided positive encouragement and support. This decreased the feeling of anxiety and alleviated the symptoms of physical and mental discomfort, which helped the patient undergo stable and continuous peritoneal dialysis to achieve the best quality of life. We hope that this care experience can provide a reference for clinical staff when taking care of similar patients in the future.

This paper describes the nursing experience of caring for a 52-year-old female patient who underwent peritoneal dialysis for a year and experienced physical and mental discomfort due to comorbid diaphragmatic hernia. The care period was from March 5 to 16, 2016. The authors used Gordon’s 11 Functional Health Patterns as a guide and conducted interviews, observations, and a physical assessment and examined her medical records to collect information. We found that the patient had an ineffective breathing pattern, acute pain, anxiety, and other health problems. During the care period, we proactively showed concern, listened to her needs, encouraged the patient to verbalize her innermost thoughts, and respected her views about not converting to hemodialysis. We provided personalized nursing aid to alleviate her physiological discomfort, taught her deep breathing, relaxation techniques, and limb massage to alleviate postoperative wound pain. We also proactively discussed her preoperative anxiety with the medical team, provided relevant information and nursing guidance, and cleared pertinent doubts. In addition, the companionship of her relatives and shared experiences with other dialysis patients provided positive encouragement and support. This decreased the feeling of anxiety and alleviated the symptoms of physical and mental discomfort, which helped the patient undergo stable and continuous peritoneal dialysis to achieve the best quality of life. We hope that this care experience can provide a reference for clinical staff when taking care of similar patients in the future.