一位糖尿病腎病變病人首次接受血液透析之照護經驗

Care Experience of A Patient with Diabetic Nephropathy Receiving Hemodialysis for the First Time

本文闡述一位年輕女性罹患第1型糖尿病長達17年，因雙下肢嚴重水腫合併呼吸窘迫緊急血液透析治療，產生了極大壓力而出現不安、害怕的情緒反應。護理期間自2021年1月18日至2021年1月30日，運用Gordon十一項健康功能型態為評估工具，以會談、觀察、身體評估及病歷查閱等方式收集資料，分析歸納個案主要護理問題為體液容積過量、無望感及特定知識缺失。在照護過程中與個案建立良好護病關係，以主動關懷、鼓勵表達內心想法，運用個別性護理措施及專業知識，指導水分控制、利用食物圖卡，以紅、黃、綠燈概念，教導高血磷食物的分辨及降磷藥物正確的服用方式。同時觀察個案在透析初期面臨疾病之衝擊造成的無望感，運用傾聽、強化家庭支持系統及腎友經驗分享，以減輕不安的情緒，針對年輕族群建議透析護理師早期介入心理調適的醫療照護，因應個別需求，協助正向面對血液透析後的生活改變，重新規劃未來生活的藍圖。

This article illustrates the case of a young woman who has been living with type 1 diabetes for 17 years. Due to severe edema in both lower limbs and resulting respiratory distress, she underwent urgent hemodialysis treatment, which caused immense stress leading to feelings of anxiety and fear. The nursing care took place from January 18, 2021, to January 30, 2021. Using Gordon's Eleven Functional Health Patterns as the assessment tool, data was collected through interviews, observations, physical assessments, and review of medical records. The analysis concluded the primary nursing issues for the case were fluid volume overload, feelings of hopelessness, and specific knowledge deficits. During the care process, a strong nurse-patient relationship was established. The nursing team engaged in proactive care and was encouraged to express inner thoughts. We applied individualized nursing measures, professional knowledge, and guidance on fluid control. We also utilized food charts and the concept of red, yellow and green lights to educate about high-phosphorus foods and the correct method to take phosphorus-lowering drugs. Simultaneously, the nursing team observed feelings of hopelessness in the patient, particularly in the early stages of dialysis. Strategies such as listening, reinforcing family support systems, and sharing experiences among patients who had experiences with kidney issues were employed to alleviate anxiety.
For the patients who have experienced the condition and needed hemodialysis at a young age, the article suggests early intervention by dialysis nurses in psychological support as a part of medical care to meet individual needs. And assist in positively facing life changes after starting hemodialysis, thereby redefining the blueprint for future life.