一位尋常型天疱瘡病人初次血液透析之照護經驗

A Nursing Experience of a Pemphigus Vulgaris Patient with First Hemodialysis

本文描述罹患尋常型天?瘡中年男性，長期全身皮膚黏膜受損及水泡傷口，於門診治療期間中斷服藥另以中藥及偏方治療，導致慢性腎衰竭需接受血液透析治療之護理經驗。照護期間為2018年3月15日至4月28日，運用Gordon十一項功能性健康型態評估，確認個案健康問題有高危險性感染、潛在危險性跌倒及無望感。照護過程提供導管留置及皮膚傷口照護指導，鼓勵攝取富含鐵質食物減少貧血，控制水分攝取，避免透析中低血壓的發生並改善家中環境安全以預防跌倒，引導表達內心感受及正向思考，提昇自我價值感和自信心，使個案能面對及調適疾病過程和長期透析生活的改變，也期望此文能作為此類罕見免疫疾病的血液透析病人之臨床照護參考。

 

This article describes a nursing experience of a middle-aged male with pemphigus vulgaris suffered from long-term systemic skin and mucosal damage and blister wounds, who treated in an outpatient setting. During this period, Western medication was interrupted and treated with traditional Chinese medicine and remedy, which lead to chronic renal failure requiring hemodialysis. The period of care is from March 15 to April 28, 2018. Eleven functional health assessments of Gordon were used to confirm the individual’s health problems, and confirmed the patient had a high-risk for infections, potentially dangerous falls, and a sense of hopelessness. The care process provides guidance on catheter indwelling and skin wound care, encourages the intake of iron-rich foods to reduce anemia, controls water intake, avoid the occurrence of hypotension during dialysis and improve the safety of the home environment to prevent falls, guide the expression of inner feelings and positive thinking, promote self-worth and confidence. Therefore, the case can face and adjust the disease process and long-term dialysis life changes. We hope that this article can be used as a reference for clinical care of hemodialysis patients with such rare immune diseases.