照護一位末期腎病變青少年接受腎臟移植手術之護理經驗

Abstract

本文描述一位罹患末期腎病變之青少年接受腎臟移植手術的護理經驗。筆者於2019年1月6日至1月30日護理期間，運用身、心、靈、社會整體性評估，確認個案有急性疼痛、焦慮、潛在危險性感染及知識缺失等健康問題。 在疼痛方面，除教導使用固定帶固定傷口和使用別針固定引流管避免拉扯外，並鼓勵採深呼吸放鬆等技巧，以轉移疼痛的注意力；在執行護理活動前均詳細說明步驟與目的，並使用通訊軟體參與病友團體討論，藉由正向經驗分享，來增加對未來生活的信心並降低焦慮感；此外也指導傷口照護、協助認識感染徵兆及瞭解配戴口罩和勤洗手的重要，以降低危險性感染。最後，與個案共同訂定學習目標、提升移植術後自我照顧知識和增進其對藥物的瞭解及記憶，並鼓勵養成良好生活習慣、提醒按時回診追蹤，最終使問題獲得解決。期望藉此經驗分享提供臨床照護參考。  This article describes a nursing experience of a teenager with end-stage renal disease who successfully underwent kidney transplantation. During the nursing period from January 6 to January 30, 2019, the author confirmed that the patient had health problems of acute pain, anxiety, potential risks for infection, and a lack of knowledge through holistic assessments. The care processes for reducing his pain perception included the use of tapes or pins to fix the wound and drainage tubes and ways to divert attention from pain. In terms of lowering his anxiety, we explained the purpose and process comprehensively before each nursing care. In addition, we encouraged him to use communication software to participate in group discussions and share positive experiences to increase confidence for future life. We also educated the patient on how to reduce the risk of infection by performing good wound care, recognizing early signs of infection, and understanding the importance of wearing a mask and washing his hands frequently. Finally, we set the same learning goals together, enhanced his knowledge and memory of immunosuppressive drugs, encouraged good living habits, and reminded him to return to the outpatient department on time, eventually solving the problems. We want to share these experiences to provide a reference for clinical care.