照護一位首次接受透析治療的腎功能損傷病人之護理經驗

本文描述一位因腎功能損傷伴隨致命性高血鉀風險，使其面臨初次血液透析之護理經驗，經團隊評估後，需長期血液透析的個案，其日常生活受限、家中角色改變進而產生無力感，照護期間為2020/1/16~2/2。護理過程中藉由直接照護、身體評估、主動關懷及開放性會談等方式收集資料，發現主要健康問題有：一、呼吸喘，二、透析飲食執行度不佳，三、無力感。照護期間透過圖表（卡）教導個案測量水腫情況，並透過水壺、磅秤讓個案學習飲食及水份控制技巧，與其搭配營養師衛教及食品營養成分資料庫，增加個案對飲食資訊管道，並考量個案生活習慣下建立提醒機制，如：製作小吊飾或手機鬧鈴等個別性護理措施，加上家人支持、宗教信仰成為心靈上慰藉及腎友的經驗分享，引導個案接受目前扮演的角色，與疾病共存生活。建議往後照顧類似案例能融入家屬的參與，並思考如何強化醫療成員自我主動學習心理諮商輔導課程意願，讓往後面對此案例時能有更好的因應之道。  This paper describes the case of a patient with worsening renal function accompanied by electrolyte disturbance who required long-term hemodialysis after assessment by a medical team. The patient felt helpless due to restrictions in daily life and changes in their family role. The care period was from January 16 to February 2, 2020. In this period, observations, direct care, physical evaluation, medical record inspection, active concern, and open interviews were used for collecting information. Major health problems found included the following: 1. shortness of breath; 2. poor execution of dialysis diet; and 3. a sense of powerlessness. During the care period, picture teach the case to measure edema, and let the case study dietary water control skills through the use of water bottles and scales, nutrition-related information websites and several types of reminder mechanisms were employed, such as using cell phone charms or mobile alarms, to help the patient understand correct information on various dietary components and accept their current family role. This was done to make living with the disease easier for the patient. We recommend the inclusion of family participation for future studies on care of patients with similar conditions. Also, we should think of devising ways for increasing medical staff’s willingness to proactively take psychological counseling courses so that they can respond better to such cases in the future.