一位罹患A型免疫球蛋白腎病青少女初次血液透析之護理經驗

Nursing Experience of A Young Girl with IgA Nephropathy who Received Initial Hemodialysis

本文為一位青少女因IgA腎病初次接受血液透析治療，疾病進展快速，使個案及案父母產生焦慮及照護認知不足之護理經驗。護理期間自2020年06月15日至07月10日，運用Gordon十一項健康功能型態評估，以直接照護、會談、身體評估及跨科部會議等方式收集資料，確立個案健康問題有:營養不均衡、焦慮、照顧者角色緊張。照護過程中，透過陪伴、傾聽與案家建立信任之護病關係，藉由飲食日誌設計個別性菜單、透過跨科部會議調整飲食攝取模式，以改善營養不均衡；利用漫畫繪本、健康管理工具，提升自我照護技能，減輕其焦慮；同理父母心理壓力，討論照護工作之分配、喘息減壓方式，降低照顧負荷，使個案學會自主健康管理，進而達到親子共責之健康管理模式。因應蔬食飲食人口的增加，建議偕同營養師設計「透析素食菜單」，讓病人保有自己喜好的飲食模式，以增加疾病的適應性，藉此護理經驗作為日後照護此類病人之參考。

We reported a young girl who began to receive hemodialysis due to IgA nephropathy. Our nursing experience focus on her and her parents’ anxiety and lack of caring cognition due to rapidly progressive disease. During our nursing period from June 15th to July 10th, 2020, we used the “Gordon 11 Function Health Patterns” to collect data by direct care, interviews, physical examination and multi-disciplinary discussion. We found that our case had health problems including nutritional imbalance, anxiety and caregiver role strain. Furthermore, we established a trusting relationship by accompany, listening and building trust with her family. We used diet diaries to create individualized menu, used interdisciplinary team meetings to improve nutritional imbalances, and used comic books and health management tools to improve self-care skills and reduce anxiety. We empathized with parents’ psychological pressure, discussed the distribution of care work, provided respite care, reduced care load, taught her self-health management and then achieved the health management model of parent-child shared responsibility. In response to the increase in the population of vegetarian, we designed a "vegetarian menu for dialysis" with our dietitian. Therefore, the patients could maintain their own dietary preference to increase the adaptability to diseases. We took this nursing experience as a reference for the care of such patients in the future.