照護一位類風溼性關節炎患者面對血液透析治療之護理經驗

The Nursing Experience from Taking Care of a Rheumatoid Arthritis Patient Undergoing Hemodialysis

10.3966/172674042016061502007

李秀珠(Shiow-Ju Lee)；陳秋惠(Chiu-Hui Chen)

類風溼性關節炎 ； 血液透析 ； 營養 ； 自我照顧能力 ； 無望感 ； rheumatoid arthritis ； hemodialysis ； nutrition ； self-care ability ； hopelessness

臺灣腎臟護理學會雜誌

15卷2期（2016 / 06 / 01）

83 - 95

繁體中文

本文旨在探討一位長期罹患類風溼性關節炎病人，合併末期腎臟病接受血液透析治療之護理經驗。護理期間為2012年6月14日至7月14日，筆者應用Gordon十一項功能性健康型態為評估工具，運用觀察、會談及身體評估技巧收集資料，發現個案因罹患類風溼性關節炎導致關節僵硬、變形，致日常生活部份無法自理，且透析過程需家人陪伴，依賴性高，面對末期腎衰竭接受血液透析治療，生理上產生營養不足而心理感受沒有未來、抱著負面的想法。歸納出個案主要的護理問題有：（1）營養不均衡：少於身體需要、（2）自我照顧能力缺失、（3）無望感等。經由主動關懷個案需求，並透過護理活動的介入，利用護理專業知識，配合衛教單張、輔具的使用及跨科室醫療諮商，改善個案因疾病所引起的營養不足，提升自我照顧能力，預防關節繼續僵硬惡化、變形；運用傾聽、陪伴及同理心、給予個案鼓勵、提供勵志書籍、病友的經驗分享，以提升個案的希望，使其接受透析的治療並體認生命的價值與意義。期望藉此照護經驗分享，提供護理同仁對此類病患照護之參考。

This study examines the nursing experience from taking care of a patient with a long history of rheumatoid arthritis undergoing hemodialysis. The patient suffered from renal failure due to hypertension and improper intake of dietary supplements (notably grape seed extract). The care period spanned June 14, 2012 to July 14 of the same year. This study utilized Gordon's 11 functional health patterns as the assessment method and collected data through observation, interviews, and physical assessment skills. It was discovered that the patient's joints had become deformed and stiff due to rheumatoid arthritis. The patient was therefore unable to function independently and needed to be accompanied by family members during the hemodialysis process. Faced with hemodialysis required by end-stage renal disease, the patient began suffering from physical malnutrition as well as psychological effects such as hopelessness and negativity. The main problems with the patient's care included: (1) imbalanced nutrition - below the body's requirements; (2) lack of self-care ability; (3) sense of hopelessness. By actively taking care of the patient's needs, nursing intervention, professional nursing knowledge, along with patient instructions, assistive devices, as well as interdepartmental medical counseling, all helped to achieve improvements in the patient's nutrition and self-care ability. The condition of the joints were also stabilized to prevent further stiffening and deformation. Measures such as listening, companionship and empathy, provision of inspirational books, and sharing of other patients' experiences also helped the patient feel more hopeful about the future. This study was able to convince the patient to recognize the value and meaning of life. By sharing this nursing experience, this study hopes to provide fellow colleagues with a reference for taking care of patients with similar symptoms.

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