照護一位末期腎病變病人初期接受血液透析之護理經驗

Nursing care Experience of a Patient with End-stage Renal Disease During Initiation of Hemodialysisew

本文為探討一位42歲男性，本身為第四期慢性腎臟病病人，此次因慢性腎臟病進展至末期需長期血液透析，初期病人對於學習血液透析日常自我照護不熟悉，內心充滿無助感和焦慮等負向情緒，引發筆者撰寫此文之動機。照護期間為2024年8月8日至9月24日。透過觀察、身體評估與會談，運用Gordon十一項健康功能型態確立健康問題為：體液容積過量、營養少於身體所需及焦慮。照護期間筆者主動關懷及傾聽，跨團隊合作偕同營養師及家屬個別化諮詢、醫囑藥物治療（Albumin、EPO、鐵劑）、飲食日誌監控、中醫五柱穴位按摩及安排病友團體經驗分享。成功使病人兩次透析間體重增加維持於3-5％之標準；結合少量多餐、優質蛋白質攝取與穴位按摩，有效提升食慾，使營養生化指標回歸正常、藉由醫院焦慮量表（HADS）監測與正向回饋，並透過模範腎友分享，成功緩解個案焦慮，使其能以積極態度面對透析生活。維持良好的營養狀態，是透析腎友維持良好生活品質的重要因素，建議臨床實務應針對營養不良高風險透析病人，積極介入提供個別化營養諮詢和定期追蹤，才能達到延緩腎臟功能惡化及提升腎友的生活品質。

We describe the nursing care experience of a 42-year-old man with stage 4 chronic kidney disease (CKD) who progressed to end-stage renal disease and required long-term hemodialysis. At the initiation of hemodialysis, the patient was unfamiliar with required daily self-care and experienced significant feelings of helplessness and anxiety. These challenges motivated the author to document this case. The care period spanned from August 8 to September 24, 2024. Patient data were collected through observation, physical assessment, and interviews. Gordon’s 11 Functional Health Patterns were used to identify the patient’s main health problems, including excess fluid volume, inadequate nutritional intake, and anxiety. Throughout the care process, the author provided continuous emotional support and attentive listening while working closely with a multidisciplinary team, including dietitians and the patient’s family, to deliver individualized care. Medical treatments prescribed by physicians, including albumin, erythropoietin, and iron supplementation, were administered. Additional nursing interventions included dietary diary monitoring, traditional Chinese medicine’s five-point acupoint massage, and participation in peer support group activities. These interventions successfully maintained the patient’s interdialytic weight gain within the recommended 3-5% range. A strategy combining small, frequent meals, adequate intake of high-quality protein, and acupoint massage effectively improved appetite and normalized nutritional biochemical indicators. Anxiety level assessment using the Hospital Anxiety and Depression Scale (HADS) found that positive feedback and shared experiences from fellow dialysis patients significantly reduced the patient’s anxiety, allowing him to approach dialysis with a more positive and adaptive attitude. Maintaining adequate nutritional status is essential for preserving quality of life in patients undergoing hemodialysis. Clinical practice should thus emphasize early identification of dialysis patients at high risk of malnutrition and provide proactive, personalized nutritional counseling and regular follow-up to delay disease progression and improve overall quality of life.