一位罹患肺腺癌的末期腎病變病人首次接受血液透析之護理經驗

Abstract

本文為一位罹患肺腺癌的末期腎病變病人，面臨雙重重大疾病治療的壓力下，接受初次化學及血液透析治療的護理經驗。護理期間於2018年7月31日至9月30日，運用Gordon十一項健康功能型態為評估工具，透過直接照護及觀察等方式蒐集資料，確認病人有體液容積過量、營養失衡及無望感等健康問題，透過回覆示教及教導病人水分控制技巧，改善因體液容積過量所致呼吸喘的症狀；經偕同營養師制定飲食治療計劃，改善因化學治療副作用導致的營養失衡；藉由跨團隊照護、家人及病友支持，成功地使病人適時表達因雙重重大疾病所產生的經濟壓力困境與對未來生活價值的無望感。冀望將此照護經驗分享，讓同性質病人能坦然面對生命逆境，順利進入化學及血液透析治療，早日回歸職場。  This article was about a patient with end-stage renal disease and lung adenocarcinoma and then she received nursing experience of initial chemical and hemodialysis . The author cared for such a patient from July 31, 2018 to september 30, 2018, Using Gordon’s 11 functional appraisals and both observation and discussion, the following patient’s care issues were identified ,including fluid overload , malnutrition, hopelessness .With these,we can teach the patient skills to control water,and improve the symptoms of asthma caused by fluid overload.Also,we can formulate a diet therapy plan with a dietitian to improve the nutritional imbalance caused by the side effects of chemotherapy. With cross-team care, family and patient support,we can successfully make the patient talk about their difficulties cause by double major diseases in a timely manner,and hopeless economical pressure . I hope to share this care experience and recommend it to the case care seminars of related units.With this, patients of the same nature can face life’s adversity calmly and smoothly.Then,patients will be willing to choose the chemical and hemodialysis treatments, and return to the workplace as soon as possible.