一位因糖尿病併發末期腎病變女性患者之護理經驗

The Experience of Nursing Care for a Female Patient with Diabetic End-Stage Renal Disease

本篇報告主要是敘述一位因糖尿病併發末期腎病變女性患者之護理經驗。個案因糖尿病控制不良導致腎病變，住院期間藥物治療後仍無法改善尿毒症狀，而需面臨長期血液透析之身心衝擊。筆者於2016年11月7日至2016年11月16日期間，運用Gordon十一項功能性健康型態為評估工具，透過身體評估、觀察、會談等收集資料，發現個案有體液容積過量、知識缺失及身體心像紊亂之健康問題。針對上述問題，與個案建立良好護病關係，依照個案個別需求提供透析治療及管路照護等相關資訊，加強個案正確認知且避免管路感染；藉由圖片教導食物中的鈉、鉀、磷含量，及使用鹹度計嚴格控制水分及鹽分，避免併發症產生及體液容積過量。為協助個案順利接受血液透析治療，引導個案建立正向思考、肯定自己，鼓勵其表達內心感受並提供個案改變自己外觀的相關訊息，讓其積極正向面對疾病所造成之身體心像改變，提升自我照護能力，進而維持後續透析治療之生活品質。筆者希冀藉由本文中所提供之相關照護，供臨床護理人員針對末期腎病變個案行血液透析之參考，以期達全人照護目標。 This report described the experienceof nursing care for a female patient withdiabetic end-stage renal disease because ofpoorly controlled diabetic mellitus. Duringhospitalization, medical treatment failed toimprove her uremic symptoms. Long-termhemodialysis is recommended, which leadto an adverse impact on both physical andpsychological condition of the patient. Inthe period of nursing care from November7, 2016. to November 16, 2016. we assessedthe patient's nursing problem by physicalexamination, observation, and interviewson the basis of the principle of the Gordon'sFunctional Health Patterns. We found that themajor problem of the patient includes fluidoverload, a lack of knowledge of illness, andbody image disturbance. Firstly, well nursepatientrelationship was established. We thenprovided specific information of hemodialysisaccording to individual needs, we educated thepatient about correct concept of catheter care toprevent catheter infection. We also instruct thepatient to comprehend the sodium, potassium,and phosphorus content of foods with pictures. Astrictly water and salt limitation with salt meterto prevent the complications and fluid overloadwas implemented. Finally, in order to helpthe patient to accept the fact of hemodialysis,we encouraged the patient to express herfeeling, trying to be positive thinking and selfaffirmation,and to enhance the ability of selfcare.By sharing this care experience, we hopeto provide other nurses a practical conceptionabout the comprehensive care of a hemodialysispatient with end-stage renal disease to achievethe holistic nursing goal.