一位腹膜透析病人因反覆性腹膜炎轉換血液透析之護理經驗

Nursing Experience of a Peritoneal Dialysis Patient Switched to Hemodialysis Due to Rrecurrent Peritonitis

本篇旨在探討協助一位腹膜透析病人因反覆性腹膜炎轉換血液透析之護理經驗。護理期間為2021年3月11日至3月30日，藉由會談、觀察、身體評估及查閱病歷方式收集資料，運用Gordon十一項健康功能型態進行評估，確立個案之主要健康問題為：潛在危險性感染、體液容積過量、特定性知識缺失、無望感。經由筆者提供個案個別性的護理指導，澄清不同透析治療方式與日常生活照護的差異性，並教導新建瘻管通路之照護措施強化瘻管功能，適時鼓勵個案表達感受及澄清疑慮，增進個案對血液透析治療之疾病認知，運用關懷、同理心、陪伴及支持技巧。建議單位製作影音多媒體衛教影片，啟動整合式照護模式資訊網，善用社會支持系統及專業溝通技巧，增進個案學習之自我照顧行為，協助個案渡過轉換治療的適應過程及正向的態度面對疾病。期望此護理經驗能提供透析護理人員照護此類病人之參考。

The purpose of this article is to discuss the nursing experience of assisting a peritoneal dialysis patient to switch to hemodialysis due to recurrent peritonitis. The nursing period is from March 11 to March 30, 2021, and information is collected through interviews, observations, physical assessments and review of medical records. Using Gordon's eleven health functional types to evaluate, the main health problems of the cases were identified as: potentially dangerous infection, excess body fluid volume, lack of specific knowledge, and hopelessness. The author provides individual nursing guidance to clarify the differences between different dialysis treatment methods and daily care. In addition, the author teaches the nursing measures of newly-built fistula access to strengthen the fistula function, encourage patients to express their feelings and clarify their doubts in a timely manner, improve patients' awareness of the disease in hemodialysis treatment, and use caring, empathy, companionship and support skills. The author makes good use of the social support system and professional communication skills to enhance the self-care behavior of the case study, assist the case to go through the adaptation process of conversion therapy and face the disease with a positive attitude. It is hoped that this nursing experience can provide reference for dialysis nurses to care for such patients.