照顧一位初次腹膜透析病人導管滲漏之照護經驗

本文描述一位罹患末期腎病病人初次接受腹膜透析治療因導管滲漏引發傷口皮膚不適及焦慮情緒之護理經驗。護理期間為2019年1月2日至2019年3月8日，筆者運用Gordon十一項健康功能評估為指引，透過直接照護、會談、觀察和查閱病歷等方式收集資料分析，確立個案有：營養狀況少於身體所需、潛在危險性感染及焦慮等健康問題。護理過程中，會診營養師並藉手機APP、衛教單張及影片來增進其對透析飲食的認知，以達到營養狀況改善；協助指導導管傷口的照護，遵守無菌原則換藥，避免皮膚受損預防感染發生；採取主動關懷，鼓勵說出內心感受，協同醫師說明再次手術過程增進信心，教導放鬆技巧及精油按摩，以減低焦慮感。希望此照顧經驗，能提供臨床照護類似個案之參考。  This article describes the nursing experience of a patient suffering from end-stage renal disease undergoing peritoneal dialysis for the first time because of catheter leakage caused by wound skin discomfort and anxiety. The nursing period is from January 2 to March 8,2019.The author used Gordon’s eleven health function assessments as a guide to collect data and analyze through direct care, interviews, observations, and medical records. The problems are as follows: Health problems such as nutritional status less than what the body needs, potentially dangerous infections and anxiety. During the nursing process, consult a nutritionist and use the mobile phone APP and Health Education Leaflet and video to enhance the cognition of dialysis diet, so as to improve the nutritional status; assist in guiding the care of catheter wounds, follow the principle of aseptic techniques, and avoid skin damage to prevent infection；Take active care, encourage patient present inner feelings, cooperate with the doctor to explain the procedure again to increase confidence, teach relaxation techniques and massage with essential oils to reduce anxiety. I hope that this care experience can provide a reference for clinical care of similar cases.