一位末期腎病變合併膿胸病人初次接受血液透析之護理經驗

Nursing Experience of a Patient with End Stage Renal Disease and Empyema Receiving Initial Hemodialysis

10.3966/172674042018031701006

林秋菊(Chiu-Chu Lin)；楊美英(Mei-Yin Yang)；陳姿妃(Tzu- Fei Chen)；陳繪竹(Hui-Zhu Chen)

末期腎病變 ； 血液透析 ； 膿胸 ； 呼吸訓練 ； 焦慮 ； end-stage renal disease ； hemodialysis ； empyema ； respiration training ； anxiety

臺灣腎臟護理學會雜誌

17卷1期（2018 / 03 / 01）

70 - 85

繁體中文

本文為一位末期腎病變合併膿胸個案，初次接受血液透析治療的護理經驗。於2014年07月05日至08月29日護理期間，運用Gordon十一項健康功能型態為評估工具，透過直接照護、會談、傾聽、觀察等收集與分析資料後，確認病人有低效性呼吸型態、焦慮及營養不均衡等健康問題。照護過程中透過護理指導與回覆示教，教導病人呼吸訓練的技巧，改善呼吸困難的症狀；經由主動關懷與教導放鬆技巧，並透過家人的支持與腎友的經驗分享，安撫病人因初次透析扎針不順所引發的焦慮情緒。而病人因感染與末期腎病變導致營養失調，藉由跨領域團隊照護，共同擬定透析飲食治療計畫，導入正確觀念，以達成營養均衡的目標。藉此照護經驗分享，讓末期腎病變病人可以勇敢面對生命挑戰，順利的進入透析治療。

This paper described the nursing experience of a patient with end-stage renal disease and empyema. During the nursing period from July 05, 2014 to August 29, 2014, using Gordon's 11 Health Functional Health Patterns as the assessment tool. This patient's data was collected through methods of direct caregiving, communication, listening, and observation, etc. The results of analysis confirmed that the patient had several health issues including ineffective breathing pattern, anxiety, and imbalanced nutrition. During the nursing process, the patient's dyspnea symptoms were relieved through offering constant feedback, demonstrating, and teaching of ＂breath training＂ technique. Secondly, by encouraging the patient's family members to participate in the caring program, the case's anxiety due to unsuccessful needle puncture during dialysis was reduced. Moreover, through the experience sharing from other hemodialysis patients and being taught the relaxation technique, the patient was able to achieve emotional stability. As to the patient's nutritional disorder issue due to infection and end-stage renal disease, an interdisciplinary team care was given and both physician's and nutritionist's recommendations were included in the development of a dialysis diet treatment plan. After introducing the correct concept of diet into the patient's daily life, the patient finally achieved the goal of obtaining nutritional balance. It is hoped that, patients with end-stage renal disease can bravely face and overcome this life challenge and be able to adjust to receiving dialysis treatment through the sharing of this nursing experience, and ultimately living a life of dialysis with freedom.

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