一位敗血症引發急性腎損傷病人之加護經驗

Nursing Experience Involving a Patient with Sepsis-Induced Acute Kidney Injury

本文個案為30 歲女性，因泌尿道感染，造成敗血症而衍生器官衰竭入住加護病房。於2017 年1 月14 日至1 月19 日照護期間，藉由觀察、會談、傾聽、電子病歷查閱及身體評估等方式進行資料收集，運用Gordon 十一項健康功能型態評估，確立健康問題有：腎組織灌流改變、現存性感染、焦慮等，擬定護理計畫。配合臨床及身體狀況補充體液電解質，以矯正血液檢查值的平衡，並藉由跨領域團隊合作照護，共同努力協助因應敗血症併發急性腎損傷的病程，避免系統功能持續惡化，使血中肌酸酐值自7.8 mg/dl 降至4.3 mg/dl、尿量指標≥ 0.5 mL/kg/hr；藉由加強對於泌尿道感染相關知識，以協助現存性感染控制，WBC 自10.8*10 3 /uL 降至7.6*10 3 /uL、CRP 13.5 mg/dl 降至7.6 mg/dl；運用傾聽、溝通技巧及提供相關照護知識，減輕因疾病造成的焦慮，引導抒發焦慮之感受，焦慮指數由18 分降至10 分。期望藉由此敗血症引發急性腎損傷病人個案經驗分享，增加對急性腎損傷的照護觀念。

 

This case study involved a 30-year-old woman who was admitted to theintensive care unit due to sepsis-induced organ failure, which developed from a urinary tract infection. During the nursing period from January 14 to January 19, 2017, data were collected through observation, interviews, listening, electronic medical record review, and physical assessment. Assessment was performed using Gordon’s 11 functional health patterns, and a care plan was formulated in response to the patient’s health problems: altered renal tissue perfusion, existing infection, and anxiety. Body fluid electrolytes were replenished based on clinical and physical conditions to correct their balances. A collaborative care plan involving interdisciplinary teamwork was implemented in response to the sepsis-induced acute kidney injury to avoid the deterioration of the patient’s systematic functions, thereby reducing the blood creatinine value from 7.8 mg/dL to 4.3 mg/dL while maintaining the urine output index at ≥ 0.5 mL/kg/hr. The patient’s knowledge concerning urinary tract infection was enhanced to control the existing infection, with the patient’s white blood cell count and C-reactive protein dropping from 10.8*10 3 /μL to 7.6*10 3 /μL and 13.5 mg/dL to 7.6 mg/dL, respectively. Additionally, listening and communication skills, as well as provision of relevant care knowledge were used to alleviate the patient’s disease-induced anxiety and guide her in expressing her anxieties, thereby reducing the patient’s anxiety index from 18 to 10. This experience is shared while nurses are caring for patients with sepsis-induced acute kidneyinjury conditions.