照護一位末期腎病患者初次血液透析之護理經驗

A Nursing Experience for a Patient Undergoing Initial Hemodialysis Secondary to End-Stage Kidney Disease

10.29494/LN.201506_16(2).0006

韓雅奎(Ya-Chuan Han)；余文彬(Wen-Pin Yu)；李玉秀(Yuh-Shiow Li)

末期腎病 ； 體液容積過量 ； 無望感 ； end-stage renal disease ； fluid overload ； hopelessness

領導護理

16卷2期（2015 / 06 / 01）

33 - 43

繁體中文

本篇文章是探討一位的歲男性患者在末期腎病時面臨必須緊急接受血液透析治療及人工血管通路之手術，在生理及心理產生極大的壓力與衝擊。護理期間自2012年6月7日至2012年6月14日，運用Gordon十一項健康功能評估，藉由觀察、會談及查閱病歷等方式，收集主客觀資料後確立個案有潛在危險性感染、體液容積過量，以及無望感等問題。筆者在護理期間運用醫療團隊及家屬資頓強化個案支持系統及正向思考，經由個別性護理指導及參加團體衛教以增強個案對疾病的認知及飲食相關注意事項，密切監控個案生命徵象、遵守無菌原則於導管傷口照護。希望藉由此次的護理經驗，能提供臨床護理人員照護類似此個案之參考，以達整體性護理並能提升護理品質。

This article describes a nurse's experience of caring for a 63-year-old male patient with end-stage renal disease encountering extreme stress and impacts in physiological and psychological aspects due to emergent hemodialysis therapy and artificial blood vessel graft surgery. The nursing care period was from June 7 to June 14, 2012. With the application of Gordon's 11 Functional Health Patterns Assessment, subjective and objective data were collected through patient observation, interview and medical record review. Based on the results of the data analysis, the major nursing problems were potential risk of infection, overload of fluid volume, and a sense of hopelessness. During the care period, the author enhanced the patient's support system and positive thinking through the help of a care team and family members. The patient was provided with individualized nursing guidance and group health education for disease awareness and diet-relevant information. The patient's vital signs were closely monitored and aseptic techniques for care of the graft incision were implemented. The author expects that integral care can be achieved and nursing quality can be promoted through the sharing of this experience with other nurses caring for patients in similar situations.

1. Lee, B. O.,Lin, C. C.,Chaboyer, W,Chiang, C. L.,Hung, C. C.(2007).The fatigue experience of hemodialysis patients in Taiwan.Journal of Clinical Nursing,16(2),407-413.
2. Smith, J. M.,Alloy, L. B.,Abramson, L. Y.(2006).Cognitⅳe vulnerabⅲty to depression,rumination, hopelessness, and suicidalideation:Multiple pathways to self-injurious thinking.Suicide and Lfe-Threatening Behaviw,36(4),443-454.
3. Tezel, A.,Karabulutlu, E.,Sabin, O.(2011).Depression and perceived social support from family in Turkish patients with chronic renal failure treated by hemodialysis.Journal ofResearch in Medical Sciences,16(5),666-673.
4. Yu, I. C.,Huang, J. Y.,Tsai, Y. F.(2012).Symptom cluster among hemodialysis patientsin Taiwan.Applied Nursing Research,25(3),190-196.
5. 行政院衛生福利部(2013, 6月6日)、101年國人主要死因統計結果，2013年6月15日取自http://health99.hpa.gov.tw/TXT/Healthy HeadLineZone/HealthyHeadlineDetai.aspx?ToplcNo=6798
6. 胡月娟（校閱）(2010).內外科護理學(下冊).台北:華杏.
7. 孫千雅,李碧娥,陳玫君(2009)。從否認到接受：一位重覆入院初次洗腎病息之護理經驗。台灣腎臟護理學會雜誌，8(2)，65-780。
8. 彭瓊輝,張浤榮,黃建寧(2010)。糖尿病合併末期腎臟病患者之透析選擇─文獻回顧與流程建議。中山醫學雜誌，21(1)，101-114。
9. 焦雅芳(2009)。照護一位拒絕右手腕下截肢個案之護理經驗。辦新台北護理期刊，11(1)，103-111。
10. 楊芝青(2007)。慢性腎臟病危險因子的探討。北市醫學雜誌，9，880-889。
11. 葉詩君,葉蕙芳(2007)。運用輔助療法於照護一位血液透析合併結腸癌患者無望感之護理經驗。護理雜誌，54(5)，93-98。
12. 蕭仕敏,王淑麗,吳鈴珠(2008)。協助一位慢性腎臟疾病患者接受腹膜透析預先植管的護理經驗。台灣腎臟護理學會雜誌，7(2)，22-33。
13. 蘇清菁,陳玉敏(2009)。無望感之概念分析。長庚護理，20(4)，456-462。

1. 蔡侑臻,廖秋萍,沈燕芬,何美蓮(2022)。跨團隊模式照護初次建立血管通路的末期腎病病患之護理經驗。臺灣腎臟護理學會雜誌，21(1)，47-62。
2. 蘇翎禎,許玉芬,張朔衽(2019)。一位因糖尿病併發末期腎病變女性患者之護理經驗。彰化護理，26(1)，70-83。