21 * 2013 3-8 5.5 meq/l 27.5 2012 9 2013 2 15.7 5.5 meq/l 2013 3-8 27.5 2014 1-6 10.5 12 2014 12 75,591 2014 * 104 11 29 105 3 18 105 5 5 115 20 04-22624772 cshp440@csh.org.tw DOI10.3966/172674042016061502003 105 6 15 2
22 3.1 2013Antonello, Matteo, Mitchell, & Claudio, 2014 2013 7 3 2013 3-8 TSN-KiDiT 5.5 meq/l 27.5 2012 9 2013 2 15.7 42 1,850 16 4-5 2013 8 149 30 3 231-40 10 741-50 18 1251-60 32 2161 86 58 5.5 meq/l 15 TSN-KiDiT 3.5-5.0 meq/l 5.5 meq/l 3 2013 3-8 TSN-KiDiT 5.5 meq/l 27.5 2012 9 2013 2 15.7 5.5 meq/l 2013 8 19 3 18 105 6 15 2
2013 8 21 8 22 3 8 39 79.5 71.8 84.5 N 39 79.4 69.2 64.1 2013 23 1. 18 46.2 2. 13 33.3 79.5 1. 15 38.5 2. 13 33.3 71.8 1. 8 20.5 20.5 1. 16 41.0 2. 1 1 10 25.6 84.5 3. 7 17.9 1. 13 33.3 2. 11 28.2 79.4 3. 7 17.9 1. 8 20.5 20.5 1. 16 41.0 2. 11 28.2 69.2 1. 14 35.9 2. 11 28.2 64.1 1. 6 15.4 15.4 1. 4 10.3 10.3 3 50 105 6 15 2
24 3 2013 8 5.5 meq/l 39 18 5.5 meq/ L 8 26 8 28 8 29 13 3 84.6 69.2 53.8 27.5 2008 11 61 58 N 13 11 84.6 9 69.2 7 53.8 2 15.4 3 50 100 105 6 15 2
25 護理人員 無標準化之衛教指導流程 未確實了解病人居家飲食內容 不清楚飲食方式 食物攝取方面 不清楚鉀含量之食物 未確實追蹤病人居家服藥情形 工作忙碌 不當烹調方式 輔助工具 缺乏血鉀相關衛教海報 缺乏血鉀相關衛教影片 吞嚥不易 缺乏血鉀相關團體衛教海報 外出未帶藥物 服用藥物方面家屬未提醒未按時服藥未造成生活不適疾病認知與態度方面 血液透析病人發生高血鉀 病人 知識認知不足 不遵從衛教內容 5.5 meq/l 27.5 12 98 2008 瘻 2013 Antonello et al, 2014Machek, Jirka, 105 6 15 2
26 Moissl, Chamney, & Wabel, 2010 3-5 40-120 mmol 2012 40-70 meq/ L2010 2 3-5 2010 2013McGrath, Harmon, & Bishop, 2010 Cristina 2015 0.67 meq/l 2010 2010Cristina, Ana, Telma, & Cristina, 2015 2010 105 6 15 2
27 2013 20102010 2010 3 531 5 3 1 80 458036 36 2013 9 1 2014 6 30 10 1. 13 11 13 37 2. 13 13 13 39 3. 15 13 13 41 4. 15 13 13 41 5. 13 11 13 37 6. 11 15 9 35 1. 13 13 11 37 2. 15 15 13 43 3. 13 13 13 39 4. 7 7 9 23 1. 13 11 13 37 2. 13 13 13 39 3. 13 11 13 37 531 5 3 1 80 36 105 6 15 2
28 2013 9 1 2013 10 31 1 9 2 9 4 9 25 5.5 meq/l 2013 2014 9-12 1-6 9 10 11 12 1 2 3 4 5 6 1. 2. 3. 4. 5. 6. 7. 1. 2. 3. 4. 1. 2. 3. 105 6 15 2
29 3 2 9 20 30 30 3 9 23 1 4 9 27 5.5 meq/l 2 5 10 2 10 18 5 30 6 10 3 10 21 7 10 22 2013 11 1 2014 6 30 1 11 1 12 31 3 105 6 15 2
30 5.5 meq/l 1. 2. 3 11 12 2 11 20 11 21 10:30-11:00 105 6 15 2
31 12:10-12:40 2 6 12 11 20 12 20 3 11 1 6:30-7:0011:30-12:00 17:00-17:30 2 11 15 10:00-10:1514:00-14:15 18:00-18:15 5 4 111 20 25 83.3 93.911 21 26 86.7 96.62 2014 1 3 4 TSN- KiDiT 2014 1-6 5.5 meq/l 12 2014 1 1 2014 6 30 1 TSN- KiDiT 5.5 meq/l 12 2 2014 1 22 1 23 2013 8 5.5 meq/l 39 3 1 2014 1 1 2 2014 1 105 6 15 2
32 TSN-KiDiT 2014 1-6 143 5.5 meq/l 15 10.5 2013 3-8 27.5 2014 1-6 10.5 12 110 TSN-KiDiT 5.5 meq/ L 12 2014 7 2015 4 2014 1 22 1 23 2013 8 5.5 meq/l 39 100 2014 1 100 2014 8 2014 9 2013 2014 2014 2015 3-8 1-6 7-12 1-4 149 143 145 144 5.5 meq/l 41 15 13 12 27.5 10.5 9.0 8.3 105 6 15 2
33 N 39 1. 2. 79.5 23.1 1. 2. 71.8 12.8 1. 20.5 17.9 1. 2. 1 1 3. 84.5 20.5 1. 2. 79.4 15.4 3. 1. 20.5 7.7 1. 2. 69.2 28.2 1. 2. 64.1 15.4 1. 15.4 10.3 1. 10.3 7.7 105 6 15 2
34 2008 14 52-59 2013 12132-46 2013 12 363-74 2012 11 160-72 2010 6 112-20 2010 2 171-78 2010 9214-21 2010 29 1-10 2014 http://www.nhi.gov.tw/ resource/webdata/15049_2_10312.pdf 2010 21 3322-333 2008 4 20230-234 2010 11126-28 Antonello, P., Matteo, F., Mitchell, H. R., & Clandio, R. (2014). Hyperkalemia in hemodialysis patiens. Seminars in Dialysis, 27(6), 571-576. doi: 10.1111/ sdi.12272 Cristina, A., Ana, T., Telma, S., & Cristina, G. (2015). Effect of personalized nutritional counseling in maintenance hemodialysis patients. Hemodialysis 105 6 15 2
35 International, 19, 412-418. doi: 10.111/hdi.12260 McGrath, B. M., Harmon, J. P., & Bishop, G. (2010). Palmaria palmate (D-ulse) as an unusual maritime aetiology of hyperkalemia in a patient with chronic renal failure: A case report. Journal of Medical Case Reports, 4, 301-303. doi: 10.1186/1752-1947-4-301 Machek, P., Jirka, T., Moissl, U., Chamney, P., & Wabel, P. (2010). Guided optimization of fluid status in hemodialysis patients. Nephrology Dialysis Transplantation, 25(2), 538-554. doi: 10.1093/ndt/gfp487. 105 6 15 2
36 1. a. b. 2. a. b. 3. a. 1. a. b. 1 1 c. 2. a. b. c. 3. a. 1. a. b. 2. a. b. 3. a. 4. a. 105 6 15 2
37 1. 2. 3. 1. 2. 1. 2. 105 6 15 2
38 A Project to Apply Behavior Modification to Reduce the Incidence of Hyperkalemia in Hemodialysis Patients Yu-Shan Lin Guo-Lan Chen Yi-Ching Yu Chia-Ling Lin * Abstract Hyperkalemia is common complication in hemodialysis patients. According to statistics from this department, an average serum potassium concentration of 5.5 meq/l had an incidence of 27.5% between April and August, 2013. This result was significantly higher than that reported between September, 2012 and February, 2013 (15.7%). The purpose of this project is to reduce the incidence of hyperkalemia in hemodialysis patients. The project was established to determine the cause of this result and to implement Behavior Modification for reducing hyperkalemia. The following initiatives were used to reduce hyperkalemia: low potassium diet education pamphlets, low sodium food chart, diet and medication record card, reminder cards, patient record indication card, regular group health education sessions as well as posters and low potassium diet videos. After the project was implemented, the department s incidence of serum potassium ion 5.5 meq/l declined from 27.5% (March-August, 2013) to 10.5% (January-June, 2014) and met the project target of 12%. The hyperkalemia rate of hemodialysis patients was therefore effectively reduced by implementing a series of behavior modification initiatives and a better quality of care. Key words: hemodialysis, hyperkalemia, behavior modification RN, Hemodialysis Room, Chung Shan Medical University Hospital Chung Shing Branch HN, Hemodialysis Room, Chung Shan Medical University Hospital Chung Shing Branch and Research Consultant, Department of Nursing, Chung Shan Medical University* Received: Nov. 29, 2015 Revised: Mar. 18, 2016 Accepted for publication: May. 5, 2016 Correspondence: Chia-Ling Lin No. 20, Ln. 115, Liren Rd., Dali Dist., Taichung City 412, Taiwan (R.O.C.) Telephone: 04-22624772 E-mail: cshp440@csh.org.tw DOI: 10.3966/172674042016061502003 105 6 15 2