運用自我管理策略協助一位初次血液透析病人轉腹膜透析治療之護理經驗

Use of a Self-Management Strategy in Nursing Care for a Patient Undergoing Initial Hemodialysis and Changing to Peritoneal Dialysis

10.6740/NTUHJN.202101_17(1).0008

邱美靜(Mei-Ching Chiu)；周佩君(Pei-Chun Chou)

自我管理策略 ； 初次血液透析 ； 腹膜透析 ； 透析模式改變 ； 體液容積過量 ； self-management strategy ； initial hemodialysis ； peritoneal dialysis ； dialysis mode change ； fluid overload

臺大護理雜誌

17卷1期（2021 / 01 / 01）

78 - 89

繁體中文

本文探討一位接受初次血液透析轉腹膜透析治療個案之護理經驗，護理期間自2018年6月2日至6月29日，運用Gordon 11項功能性健康型態護理評估以直接照護、會談、觀察、身體評估及病歷查閱等方式收集資料，確立個案健康問題包括：體液容積過量、無效性自我健康管理及焦慮。照護過程教導個案透過手機鬧鐘提醒用餐，避免隨意食用方便取得的加工食物，並用手機拍照功能記錄飲食與飲水，給予附圖示的衛教手冊，會診營養師並提供個案喜愛的食物種類之少鹽料理食譜等方式，運用自我管理策略以調整行為，成功的引導個案主動參與照護，學習與疾病共存，運用貝克焦慮量表持續評估個案，並以關懷、陪伴及傾聽引導個案說出焦慮情緒，給予生、心、靈及社會方面的支持。建議面對類似病情的案例，可運用全人整合醫療照護給予協助，並建議將全人整合醫療照護相關課程納入年度在職教育課程，使病人能獲得完整之照護，提升整體血液透析護理照護品質。

This case report explored the nursing experiences of a patient whose dialysis mode was changed from hemodialysis to peritoneal dialysis during the period from June 2 to June 29, 2018. Data were collected through direct care, observations, interviews, physical exams, medical records, and evaluations based on Gordon's 11-item functional health patterns. The patient's problems included fluid overload, ineffective self-health management, and anxiety. The nursing process provided support to the patient to manage his health and achieve his life goals. We used phone call alarms to remind the patient to eat, taught him to avoid inadequate food, and recorded his input and output by smartphone cameras. We also provided some educational handouts and consulted dietitians to provide the low-salt recipe. Training in the use of self-management strategies was provided to enable the patient to actively participate in his own care and live with a chronic illness. We assessed the patient using the Beck Anxiety Inventory, guided the patient to express his anxiety, and provided support for his body, mind, spiritual and social needs. Holistic health care can help patients and their families to face complicated situations. We should provide training programs to improve the quality of care during hemodialysis and emphasize on the holistic care for the patients.