透析中的動態增能時光~ 一位肌少症透析病人阻力運動訓練的照護經驗

Dynamic enhancement during dialysis: A Nursing Experience of Resistance Training in a Dialysis Patient With Sarcopenia

本文旨在描述一位70歲血液透析病人表達出自覺體力變差的憂慮且上下肢肌力每況愈下，同時筆者發現個案自我健康意識及主動學習能力良好，把握個案求知慾望強的條件，給予阻力運動訓練之護理經 驗。護理期間自2019年3月4日至2019年6月9日，以個案為中心，採Gordon十一項功能性健康型態之評估工具，運用觀察、會談、身體評估、傾聽、病歷查閱等方式收集主、客觀資料，確立主要健康問題有潛在危險性活動無耐力∕與上下肢體肌肉力量不足有關、營養失衡：少於身體需求∕與攝入量不足有關、焦慮∕與缺乏肌少症正確的資訊有關。護理過程中，藉由透析期間關係的建立，筆者發揮護理的直覺及熱情，跨團隊的協同醫師、物理治療師與營養師等介入，並邀請個案及案妻共同規劃上下肢阻力運動，擬定個別性護理計畫及教導攝取充足的營養，提供完整及專業的肌少症疾病資訊。利用每週三次的透析時間，進行阻力運動訓練及監督執行狀況，個案認真的執行及配合，看到個案肌力及營養逐漸進步，有很大的成就感，冀望藉由此經驗供臨床護理人員照護血液透析肌少症病人之參考。

 

In this report, the author reports on a 70-year-old hemodialysis patient who expressed concerns about self-perceived frailty and gradual deterioration of the upper and lower extremities. The author noticed that the patient was health-conscious and exhibited a willingness to actively learn. Taking advantage of the patient’s strong desire to learn, the author imparted the nursing experiences concerning resistance training.

The care period was between March 4, 2019, until June 9, 2019. The Gordon 11 Function Health Patterns were employed for a case-centered analysis. Subjective and objective data were collected through observations, interviews, physical examinations, listening sessions, and record reviews. The main problems were to determine whether the lack of endurance in performing risky activities was associated with a lack of muscle strength in the upper and lower extremities, whether malnutrition was present due to insufficient nutritional intake, and whether a lack of specific knowledge had led to a lack of correct information concerning sarcopenia.

The author established a relationship with the patient during dialysis. She exercised her nursing intuition and enthusiasm and collaborated with physicians, physical therapists, and nutritionists from other departments to develop suitable interventions. The patient and his wife were invited to partake in the design of a resistance training program for his upper and lower extremities and a customized care plan. They were also educated on nutrition and sarcopenia.

he patient received resistance training along with dialysis three times a week, and his performance was monitored. The patient was cooperative and dedicated. The author found it was an immense accomplishment to track the gradual improvement in the patient’s muscle strength and nutrition, and hopes that her experiences can serve as a reference for clinical nurses in providing care to sarcopenia patients receiving hemodialysis.