一位血液透析患者合併自體免疫溶血性貧血之護理經驗

Nursing Experience of a Hemodialysis Patient with Autoimmune Hemolytic Anemia

10.6647/CN.201809_25(3).0008

林育凌(Yu-Ling Lin)；王慧玲(Hui-Ling Wang)；鍾玉珠(Yu-Chu Chung)

血液透析 ； 自體免疫溶血性貧血 ； 疲憊 ； 無望感 ； 體液容積過量 ； hemodialysis ； fatigue ； hopelessness ； excess fluid volume

彰化護理

25卷3期（2018 / 09 / 01）

43 - 55

繁體中文

本文旨在探討一位血液透析患者合併自體免疫溶血性貧血之護理經驗，護理期間自2016年2月19日至4月15日，利用Gordon十一項健康功能型態為評估工具，藉由會談、觀察、身體評估及查閱病歷方式收集資料，確立個案的主要護理問題為疲憊、無望感與體液容積過量。護理期間運用主動關懷及同理心，鼓勵個案表達內心感受，依醫囑給口服類固醇及注射紅血球生成素，並提供高蛋白飲食衛教，個案的血紅素由6.1 mg/dl提升至10.5 mg/dl，以及透過背部按摩及規律運動計畫，改善個案的疲憊感。藉由醫療團隊合作及家庭支持系統的發揮，減輕個案對新疾病與治療的恐懼與不安，提升其自我照顧動機及自我控制感，進而回復往常控制飲食及水分攝取，改善呼吸喘、下肢水腫等症狀，並能維持兩次透析間體重增加小於2公斤，最終個案能正向面對疾病所帶來的生活改變與疾病共存。

This article aims to discuss the nursing experience of a hemodialysis patient with autoimmune hemolytic anemia. From February 19 to April 15, 2016, Gordon's functional health assessment guide was used to analyze data collected through interviews, observation, physical assessment, and medical records of this client. The main care issues identified for this client were fatigue, hopelessness and excess fluid volume. The author took the initiative to care for this client, and promoted the expression of inner feelings. This client was prescribed by oral administration of steroids, erythropoietin injection therapy, highprotein diet, exercise health education, and back message. Hemoglobin increased from 6.1 mg/dl to 10.5 mg/dl and fatigue gradually improved. We reduce the fear and unease about new diseases and treatment through medical teamwork and family support system. The selfcare motivation and the sense of self-control were also enhanced. This client restored normal diet and water intake, keeping the interdialytic body weight gain lower than 2 kilograms. He can eventually face the changes brought by the disease with a positive attitude and live with it.

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