75 * ** 2010 6 25 8 5 1991 2010 2010 90 2011 2010 Harwood, Wilson, Cusolito, Sontrop, & Spittal, 2009 * ** 101 2 16 101 6 6 101 6 20 30015 306 (03) 5381183 7504yuchu@mail.ypu.edu.tw DOI 10.3966/172674042013091203007 102 9 12 3
76 Willams, Sawyer, Roseman, & Allman, 2008 2010 Kugler, Maeding, & Russell, 2011 2010 Yokoyama 2009 500 700 ml 1 1.5 2010 2009 2010 Russell et al., 2011 2010 Dinwiddie & Bhola, 2010 Harwood et al., 2009 2010 Wang Chiou 2011 102 9 12 3
77 2010 2010 Willams et al., 2008 Kowalski & Bondmass, 2008 1. 2. 3. 4. Minton & Barron, 2008 2011 64 102 9 12 3
78 2000 2005 Adalat OROS 1# QD Allopurinal 1# QD Vatatin FC 0.5# HS 130 150/80 90 mmhg 2007 2009 Creatinine 2.1 mg/dl 4.6 mg/dl 2010 6 18 Creatinine 8.44 mg/dl K 6.4 mmol/l) 6 21 6 25 Creatinine 11.61 mg/dl 6 25 hickman 6 25 6 27 3 1 1.2 7 2 2 2010 6 25 8 5 1 18 20 9899 84 90 2+ 135 160/75 88 mmhg 2 150 43 45 43.2 52.8 21 kg/m 2 44 1,440 6 26 29 1,400 6 25 Hb 11.7 g/dl Albumin 3.2 g/dl 6 27 WBC 7,500 cumm CRP 1.53 mg/dl 6 30 7 1 7 2 1/3 1/2 3 1 2 1 8 12 3 5 500 800 6 25 BUN 129 mg/dl Creatinine 11.61 mg/dl 6 25 27 3 1 1.2 6 30 Creatinine 5.22 mg/dl 4 5 10 5 6 26 102 9 12 3
79 Xanax 0.5 mg 4 5 6 25 6 28 3 36.236.8 6 1 3 6 Paramol 1# TID 1 3 7 6 26 X K 3.5 mmol/dl P 5.7 mmol/dl Carbonate 500 mg 1# TID 1, 200 8 95 105 mg/dl 6 24 HbA1C 6.2 9 12 6 26 6 26 6 28 6 30 6 30 6 30 2 6 28 102 9 12 3
80 40 1 2 6 26 7/1 6 28 S1: 6/28 S2: 6/28 S3: 6/28 S4: 6/28 S5: 6/28 O1: 6/25 Creatinine: 11.61 mg/dl O2: 6/25 O3: 6/28~7/1 1,200 O4: 6/28 44.5 44 O5: 1. 6/29 2. 6/30 3. 7/1 102 9 12 3
81 1-1. 6/28 1-2. 6/28 Creatinine > 8 mg/dl 1-3. 6/28 2-1. 6/28 2-2. 6/28 2-3. 6/28 5 1 2-4. 6/28 1,200 3 300 2-5. 6/28 20 500 700 2 1 1.5 2-6. 6/29 2 3-1. 6/28 3-2. 6/29 7 10 B 10 7 3-3. 6/29 3-4. 6/30 20 102 9 12 3
82 3-5. 6/30 1 2 38 3-6. 3 7/5 1 8/5 1. 6/29 2. 6/30 500 2 1.5 6/28 7/2 43 45 3. 7/1 4. 7/5 8/5 45 6 26 S1: 6/26 S2: 6/26 S3: 6/26 O1: 6/26 O2: 6/25 O3: 1. 6/29 2. 8/5 102 9 12 3
83 1-1. 6/26 1-2. 6/26 1-3. 6/26 2-1. 6/26 30 2-2. 6/26 2-3. 6/27 10 2-4. 2-5. 6/27 2-6. 8/5 1. 6/27 2 6/25 6/26 6/28 6/29 2. 8/5 2 6 30 6/30 S1: S2: 102 9 12 3
84 S3: S4: 40 O1: 6 30 O2: O3: 2 2 1. 7/2 2. 7/5 1-1. 6/30 1-2. 6/30 2 3 1-3. 7/1 3 15 1-4. 7/1 1-5. 7/1 13:00 14:30 1-6. 7/1 1-7. 7/2 1-8. 7/2 1-9. 7/2 2-1. 6/30 2-2. 6/30 2-3. 7/1 102 9 12 3
85 2-4. 3 7/5 1 8/5 1. 7/2 2. 7/5 7/2 8/5 7/2 8/5 43 45 Wang Chiou 2011 Harwood 2009 Lee 2008 102 9 12 3
86 2011 6 15 http://www.doh.gov.tw/cht2006/ DM/DM2_ p01.aspx. 2011 304 28-32 2009 21 3182-184 2010 22 3180-187 2010 9 133-42 2010 11 116-28 Dinwiddie, L. C., & Bhola, C. (2010). Hemodialysis catheter care: Current recommendations for nursing practice in North America. Nephrology Nursing Journal, 37(5), 507-528. Harwood, L., Wilson, B., Cusolito, H., Sontrop, J., & Spittal, J. (2009). Stressors and coping in individuals with chronic kidney disease. Nephrology Nursing Journal, 36(3), 265-276. Kowalski, S. D., & Bondmass, M. D. (2008). Physiological and psychological symptoms of grief in widows. Research in Nursing & Health, 31, 23-30. Kugler, C., Maeding, I., & Russell, C. L. (2011). Non-adherence in patients on chronic hemodialysis: An international comparison study. Journal of Nephrology, 24(3), 366-375. doi: 0.5301/JN.2010.5823. Lee, A., Gudex, C., Povlsen, J. V., Bonnevie, B., & Nielsen, C. P. (2008). Patients views regarding choice of dialysis modality. Nephrology Dialysis Transplantation, 23, 3953-3959. doi: 10.1093/ndt/gfn365. Minton, M. E., & Barron, C. R. (2008). Spousal bereavement assessment a review of bereavement-specific measures. Journal of Gerontological Nursing, 34(8), 34-48. Russell, C. L., Cronk, N. J., Herron, M., Knowles, N., Matteson, M. L., Peace, L., & Ponferrada, L. (2011). Motivational interviewing in dialysis adherence study. Nephrology Nursing Journal, 38(3), 229-236. Wang, L. M., & Chiou, C. P. (2011). Effectiveness of interactive multimedia CD on self-care and powerlessness in hemodialysis 102 9 12 3
87 patients. Journal of Nursing Research, 19 (2), 102-110. doi: 10.1097/ JNR.0b013e31821b0eff. Willams, B. R., Sawyer, P., Roseman, J. M., & Allman, R. M. (2008). Marital status and health: Exploring pre-widowhood. Journal of Palliative Medicine, 11 (6), 848-856. doi:10.1089/jpm.2007.0190. 中華民國 102 年 9 月 Yokoyama, Y., Suzukamo. Y., Hotta, O., Yamazaki, S., Kawaguchi, T., Hasegawa, T.,... Fukuhara, S. (2009). Dialysis staff encouragement and fluid control adherence in patients on hemodialysis. Nephrology Nursing Journal, 36 (3), 289-297. 臺灣腎臟護理學會雜誌 第 12 卷第 3 期
88 Nursing experience with first-time hemodialysis patient experiencing treatment plan knowledge deficit, powerlessness and grief Shu- Hua Hsu Suh-Mian Wu * Yu-Chu Chung ** Abstract This case report describes the nursing experience with a patient with from chronic renal failure undergoing hemodialysis for the first time powerlessness that experienced treatment plan knowledge deficit, powerlessness and grief. During the nursing period from June 26 to July 2nd in 2010, the author used observations, interviews, physical examinations and review of medical records to identify nursing issues in the five key dimensions: body, emotion, intellect, society and spirituality. Major nursing problems identified included: treatment plan knowledge deficit, powerlessness, and grief. The application of individual nursing intervention during the nursing process educated the patient and her family on self-care of dialysis and dialysis catheter as well as proper diets for kidney disease. We encouraged the patient to learn skills that helped with caring for her disease and self-control in order to adapt to a new life with hemodialysis. At the same time, the author utilized active caring, listening and empathy to provide psychological support and encouragement to the patient and her family. The author also helped the patient cope with the grieving process after the loss of a loved one. The nursing experienced provided in this report should help nursing personnel with similar cases. Key words: hemodialysis, powerless, grief RN, Medical Ward, National Yang-Ming University Hospital RN, MSN, Lecturer, School of Nursing, Yuanpei University* RN, PhD, Associate Professor, School of Nursing, Yuanpei University** Received: Feb. 16, 2012 Revised: Jun. 6, 2012 Accepted for publication: Jun. 20, 2012 Correspondence: Yu-Chu Chung, No. 306, Yuanpei Street, Hsinchu City 30015, Taiwan (ROC), School of Nursing, Yuanpei University Telephone: (03) 5381183 ext. 7504 E-mail: yuchu@mail.ypu.edu.tw DOI: 10.3966/172674042013091203007 102 9 12 3