運用踏板運動預防血液透析病人低血壓之照護經驗

The Nursing Experience Using Pedal Exercise to Prevent Hypotension in Hemodialysis Patients

本文探討一位末期腎臟病高齡病人，於血液透析期間因反覆發生低血壓，導致身體不適與心理焦慮，護理團隊遂運用踏板運動介入作為預防及改善策略，照護期間自2024年8月1日至8月10日。筆者依據Gordon十一項健康功能型態進行全面性評估，確立三項主要健康問題，分別為：血液容積不足、肢體無力及焦慮。介入措施包括：透析期間進行低強度踏板運動以改善血液循環與穩定血壓、指導實施肌力訓練與營養補充以提升活動功能，以及心理支持與血管通路管理衛教以降低焦慮。經多面向個別性照護後，個案之透析耐受性、症狀改善與心理適應均獲正向成效。本報告旨在分享護理實務經驗，提供臨床透析護理參考，強調踏板運動於預防低血壓與提升整體照護品質之應用價值。

This is a case report on the nursing care of an elderly patient with end-stage renal disease experiencing recurrent intradialytic hypotension resulting in physical discomfort and psychological anxiety during hemodialysis. The period of care spanned from August 1-10, 2024. After conducting a comprehensive assessment based on Gordon’s Eleven Functional Health Patterns, three primary health problems were identified: deficient fluid volume, impaired physical mobility, and anxiety. The corresponding interventions employed were 1) implementing low-intensity pedal exercise during dialysis to promote blood circulation and stabilize blood pressure, 2) providing guidance on muscle strengthening exercises and nutritional supplementation to enhance physical function, and 3) offering psychological support and vascular access management education to alleviate anxiety. Through multifaceted and individualized nursing care, the patient demonstrated improved dialysis tolerance, symptom relief, and better psychological adaptation. This report aims to share actual nursing experiences and provide clinical references for dialysis nursing, highlighting the application value of pedal exercise in preventing hypotension and enhancing overall quality of care.