照護一位糖尿病腎病變病人首次透析之護理經驗

Nursing Experience in the First Dialysis of a Diabetic Nephropathic Patient

10.6692/KJN.202104_38(1).0011

許嘉芳(Chia-Fang Hsu)；宋聖芬(Sheng-Fen Sung)；龔怡心(Yi-Hsin Kung)

糖尿病腎病變 ； 血液透析 ； 照護經驗 ； Diabetic Nephropathy ； Hemodialysis ； Care Experience

高雄護理雜誌

38卷1期（2021 / 04 / 01）

122 - 132

繁體中文

本文探討一位糖尿病腎病變之中年人，因血糖控制不佳導致需長期血液透析，引發個案對未來將長期血液透析的無力感，利用Gordon十一項健康功能型態為評估工具，確立個案有血糖不穩／與生活習慣及疾病觀念不足有關、知識缺失／與暫時性雙腔靜脈導管、動靜脈瘻管傷口照護有關及無力感／與害怕永久洗腎及疾病所帶來併發症有關及照顧者角色緊張／與無照顧經驗有關等健康問題。過程中，提供糖尿病腎病變末期適當飲食指導，強化疾病自我管理；因放置暫時性雙腔靜脈導管及手術建立動靜脈瘻管，教導個案居家照護技巧及維持動靜脈瘻管良好功能注意事項。期望藉此護理經驗能提供護理人員日後照護此類病人之參考。

This article explores the case of a middle-aged patient with diabetic nephropathy. Long-term hemodialysis is caused by poor blood sugar control, causing a sense of powerlessness for long-term hemodialysis. Gordon's Functional Health Pattern Assessment identified major health problems of the patient consisting of unstable blood glucose, a lack of knowledge, and a sense of powerlessness and tension with the caregiver. Proper dietary guidance suitable for individualized lifestyle and intensified disease self-management for end-stage diabetic nephropathy were provided. In addition, due to the placement of temporary double lumen catheter and the establishment of native arteriovenous fistula (AVF), patient education regarding home-based care and AVF maintenance was also given to prevent catheter infection, facilitate a return to normal home life and improve the patient’s self-care ability. By providing relevant caring experience, nursing staff might apply such knowledge as a future reference.