照顧一位腹膜透析轉血液透析病患之護理經驗

Experience of Caring for a Patient that Switched from Peritoneal Dialysis to Hemodialysis

10.3966/172674042017091603005

沈怡君(Yi-Chun Shen)；周小玉(Hsiao-Yu Chou)；韓慧美(Hui-Mei Han)

末期腎病 ； 血液透析 ； 護理經驗 ； end-stage renal disease ； hemodialysis ； nursing care experience

臺灣腎臟護理學會雜誌

16卷3期（2017 / 09 / 01）

56 - 70

繁體中文

本文探討一位由腹膜透析轉血液透析病患的照護經驗，照護期間2014年3月26日至5月31日，筆者藉由觀察、會談、身體評估及查閱病歷收集資料，以Gordon十一項健康功能型態為評估架構，確立個案有無望感、營養不均衡：少於身體所需、皮膚搔癢問題。個案因腹膜纖維化需面臨透析模式及生活習慣的改變，自主照護行為被剝奪，產生無望感；因口腔潰瘍導致進食量少，產生營養不均衡；錯誤皮膚照護認知，產生皮膚搔癢。筆者運用同理心，建立良好的護病關係，找出個案喜愛手做物的興趣，藉由完成手做物達到成就感，讓個案重新自我價值認定，衛教口腔照護的方法及合宜食物溫度，增加個案進食量，改善營養不均衡，提供正確皮膚照護方式，藉由清涼型外敷製劑治療搔癢，將個案生、心理及社會層面之衝擊降至最低，提升生活品質。

This paper describes providing nursing care to a patient that was transferred from CAPD to hemodialysis during the period of March 26 to May 31 of 2014. By means of observations, interviews, physical exams, medical data collections, and evaluations based on Gordon's 11- item functional health patterns, the author established that the patient had several mental and physical issues, including a sense of hopelessness, imbalanced nutrition (less than body requirements), and pruritus. The patient underwent dialysis due to peritoneal fibrosis and lifestyle changes resulting in loss of self-care autonomy, less food intake because of oral ulcer which led to nutrition imbalance and pruritus from lack of proper skincare knowledge. During the care period, the author employed an empathic approach and was able to establish good caretaker-patient relationship. After finding out that the patient enjoyed making handicrafts, the caretaker encouraged the patient to pursue this hobby which brought him a sense of achievement and improved self-worthiness. The patient was educated on oral care and appropriate food temperature that led to increase of food intake and improved nutrition balance. Appropriate skin care methods were also taught to the patient, including the use of topical cooling agents to treat pruritus. The author was able to improve the patient's quality of life by minimizing the physical, mental, and social impacts suffered by the patient.

1. Andrade, S. V.,Sesso, R.,Diniz, D. H.(2015).Hopelessness, suicide ideation, and depression in chronic kidney disease patients on hemodialysis or transplantrecipients.Jornal Brasileiro de Nefrologia,37(1),55-63.
2. Combs, S. A.,Teixeira, J. P.,Germanin, M. J.(2015).Pruritus in Kidney Disease.Seminars in Nephrology,35(4),383-391.
3. Jadeja, Y. P.,Kher, V.(2012).Protein energy wasting in chronic kidney disease: An update with focus on nutritional interventions to improve outcomes.Indian Joural of Endocrinology and Metabolism,16(2),246-251.
4. Lopez-Vargas, P. A.,Tong, A.,Phoon, R. K.,Chadban, S. J.,Shen, Y.,Craig, J. C.(2014).Knowledge deficit of patients with stage 1-4 CKD: a focus group study.Nephrology,19(4),234-243.
5. Poorgholami, F.,Mansoori, P.,Montaseri, Z.,Najafi, K.(2016).Effect of Self Care Education with and without Telephone Follow-Up on the Level of Hope in Renal Dialysis Patients: A Single-Blind Randomized Controlled Clinical Trial.International Journal of Community Based Nursing and Midwifery,4(3),256-264.
6. 王雅玲(2010)。透析病患之營養補充品。腎臟與透析，22(3)，202-205。
7. 何怡德,薛如婷,王映權(2014)。慢性皮膚搔癢治療建議。家庭醫學與基層醫療，29(7)，196-202。
8. 李宜哲,洪士元(2014)。腹膜透析患者腹膜變性原因及其對透析治療所造成的影響。腎臟與透析，26(2)，92-96。
9. 林佑樺(2013)。血液透析病人之社會互動。臺灣腎臟護理學會雜誌，12(4)，1-8。
10. 林偉弘,郭冠良,夏清智,吳岱穎,陳建志(2013)。淺談慢性腎臟病。北市醫學雜誌，10(2)，101-109。
11. 馬麗卿,孫嘉玲,謝湘俐(2010)。血液透析病患之憂鬱狀態及生活品質滿意度相關性研究。臺灣腎臟護理學會雜誌，9(1)，1-16。
12. 許薳尹,吳素卿,王郁薇,周雪琦,吳佩蓉,吳紅蓮(2014)。慢性析腎臟病的蛋白質一熱量耗損的病因、診斷與營養介入。腎臟與透析，26(1)，63-68。
13. 郭麗雀,王佩穎,郭秋慧(2014)。醫療團隊資源管理在腹膜透析治療之應用。臺灣腎臟護理學會會訊，17(2)，3-4。
14. 陳曉珮,陳玉敏(2010)。慢性腎衰竭患者的營養照護。臺灣腎臟護理學會雜誌，9(2)，14-21。
15. 彭瓊琿,張浤榮,黃建寧(2010)。糖尿病合併末期腎臟病病人之透析選擇-文獻回顧與流程建議。中山醫學雜誌，21(1)，101-114。
16. 劉月敏,謝湘俐,駱敏淑,馬麗卿,張宏哲(2010)。血液透析患者的復原力與社會支持。臺灣腎臟護理學會雜誌，9(1)，33-43。
17. 衛生福利部統計處(2015,8月21 日),民國 103 年死因統計年報． 取自 http://dep.mohw.gov.tw/DOS/lp-1779-113.html
18. 鄭志雄,徐國維(2012)。末期腎臟病的安寧緩和照顧。腎臟與透析，24(1)，67-71。