一位初期腹膜透析病人併發腹股溝疝氣之照護經驗

The Nursing Experience of Caring for A First-time Peritoneal Dialysis Patient with Inguinal Hernia Impact

10.29494/LN.202009_21(3).0007

陳淑麗(Shu-Li Chen)；黃秀文(Hsiu-Wen Huang)

腹膜透析 ； 腹股溝疝氣 ； peritoneal dialysis ； inguinal hernia

領導護理

21卷3期（2020 / 09 / 01）

75 - 89

繁體中文

本文是描述一位初期腹膜透析二週併發腹股溝疝氣，除了生理不適外，加上醫師建議轉血液透析衝擊，對未來透析人生感到不安的護理經驗。筆者於2016年7月21日至8月1日護理期間，藉由觀察、會談及運用羅氏適應模式進行評估，歸納出個案因初期腹膜透析效果不佳及知識不足有體液容積過量、術後傷口疼痛及焦慮等問題。在護理期間依病人飲食記錄與個案共同設計水分管理及飲食矯正計畫改善水腫及控制正常體重，運用音樂輔助療法及放鬆技巧減輕疝氣修補術後傷口疼痛，引薦相同疾病腎友成功經驗，重建病人對腹膜透析正向信念，並運用以病人為中心決策共享技巧，協助個案對從不知所措到有自信面對未來的腹膜透析人生。後經三個月回診追蹤下，個案執行腹膜透析之健康維護成效良好且已順利回歸職場，建議臨床照護可運用醫病共享決策方法對個案清楚說明治療優缺點，以降低個案隱藏的心理壓力與不安，未來也將建立居家腹膜透析腎友臉書直播粉絲團，激發腎友擴展生命的品質，讓「腎活」更精采。

This article describes a nursing experience from caring a patient with an initial stage of inguinal hernia complicated by peritoneal dialysis for two-weeks; in addition to physical discomfort, the impact from doctor's advice to transfer to Hemodialysis, and the association with the uncertainty towards the future dialysis life. The duration of nursing care is from July 21 to August 1, 2016; the author conducted observations, interviews and used Roy's adaptation model for evaluation, and concluded that the patient had excessive fluid volume and postoperative wounds due to poor initial peritoneal dialysis and insufficient knowledge issues such as pain and anxiety. During the nursing care period, according to the patient's dietary record and the custom designed water management with the case as well as diet correction plan to improve edema and control normal body weight; use music-assisted therapy, relaxation techniques to reduce wound pain after hernia repair, introduce successful experience of the same disease, and restore the patient with positive mindsets in peritoneal dialysis, and the use of Patient-Centered decision-making and sharing skills to assist patient facing the future of peritoneal dialysis, from overwhelming to confidence. After three months of following-up, the patient's health maintenance from the peritoneal dialysis was successful and has persuasively returned to the workplace. It is recommended that clinical care can use the doctor-patient shared decision-making method to clearly explain the advantages and disadvantages of the treatment to the case to reduce the anxiety and the hidden psychological pressure and uncertainty. In the future, the home-based dialysis kidney friendship will be on Facebook as live fan group to inspire kidney friends to extend the quality of life and make 〞kidney life〞 more splendid.

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