一位末期腎病患者撤除血液透析治療的護理經驗

Nursing Experience about the Withdrawal of Hemodialysis in Patient with End Stage Renal Disease

本文旨在敘述一位末期腎病長期接受血液透析因感染導致敗血症面臨生命末期的生理、心理衝擊及心靈困擾之護理過程。筆者於2015年10月14日至2015年11月01日照護期間，運用五大層面護理評估為架構，藉由溝通、身體評估及病歷查閱等方式收集及分析主客觀資料，確立個案健康問題有呼吸道清除功能失效、體液容積過量、身體活動功能障礙、無望感及死亡焦慮。因傳統道德文化的束縛，患者及家屬害怕談論死亡而使患者即便已達生命末期，仍積極接受極盡的醫療而得不到善終，筆者運用安寧療護的症狀緩解治療、跨團隊醫療計畫及安排家庭會議，營造全人、全程、全家及全隊照護，提供個別性和即時性的護理措施，安排宗教團體支持，經由以上護理措施，不僅讓個案願意參與醫療決策及完成簽屬不施行心肺復甦術意願書，並幫助個案平順完成四道人生也完成協助個案身、心、靈安適面對臨終過程，達到善終。期望藉由本文護理經驗分享，在照護預期於6個月內將死亡或預後不佳的患者，及早提供安寧療護選擇，並提供臨床末期患者照護之照護參考依據。 This article describes the experience ofcaring a patient with end-stage renal diseasewho received hemodialysis complicated withsepsis and resulted in physical, psychological,and spiritual disturbance. The nursingperiod was from October 14 to November 1, 2015. Five facets of psychiatry assessmentwas applied. Data were collected based oncommunication, physical assessment, andmedical record reviewing. The main healthproblems were as followings: ineffectiveairway clearance, body fluid overload,functional impairment of physical mobility,hopelessness, and death-related anxiety. Because of traditional culture bound, patientand family were afraid of talking about deathwhen facing dying process. Instead, they triedaggressive treatment. But this could not givepatient good end. Author applied hospice careto relieve symptom and multidisciplinary teamdiscussion to make medical planning. Withholistic care concept, individualized nursingintervention and religious group support wereprovided. Author helped the patient to takepart in medical decision and signed Do NotResuscitate Consent. Furthermore, patientcould expressed his apology, thanks, love, andgoodbye to his family by guidance and come togood end. This case report provides referenceexperiences that should help nursing personnelto make hospice care a choice for patient in theend-of-life.