91 * 2011 4 26 2011 5 15 Gordon 2013 203 2013 2011 2012 9A * 102 8 1 102 10 7 102 11 4 62442 118 18 (06) 2812811 55901 go6662@hotmail.com DOI10.3966/172674042014061302007 103 6 13 2
92 2012 8.6 2012 2008 33 15 ml/min/1.73 m 2 2012 2008 2008 2010 30~40 2011 2009 103 6 13 2
93 5 Rimmelé & Kellum, 2010 5 8 500~700 ml Holechek, 2004 2009 2007 2009 2008 2008 2000 2008 2006Clare, 2007 2011 2011 4 26 2011 5 15 Gordon 33 103 6 13 2
94 57 歲高血壓工人 57 歲工人 33 歲工人 33 歲服務業 31 歲工人 29 歲工人 27 歲美髮師 12 歲小學生 8 歲小學生 2008 30 2011/4/26 24 105 169/101 mmhg 91 ph7.32paco 2 22.5 mmhgpao 2 83.5 mmhg HCO 3 26 meq/l 125 mg/dl 13.61 mg/dl 10 ml/min/1.73 m 2 5.1 meq/lhb10.5 g/dl X 2011/4/26 2011/4/29 20~22 x 2011/5/1 2011/5/4 5/4 103 6 13 2
95 4 2 2011/5/7 8020/uL 36.2~37.5 5 11 2011/5/11 2011/5/15 7 AM13 PM18 PM 23 PM 2.5 Dianeal 2000 ml 55 mg/dl 5.4 mg/dl 3.6 meq/l 2011/5/20 Gordon 2008 2011 4 26 5/1 30 50 153 44.82 ~ 54.78 21 18.5 BMI 244/26 52 3 24~28 X 1,500 ml/day4/27 4/27 1,700 kcal/ day 75 g/day 3~4 g/day 4/26 Albumin3.1 g/dl 4~5 1,000~1,350 cc/day 4/26 700 cc/ day 103 6 13 2
96 4/26 12-16 - 2-3 30 4/26 10~20 24~28 4/29 5 3 20~30 19~20 85~95 115/102~165/112 mmhg 4/29-11 7 8 4/30 4/30~5/1 6~7 1~2 1~2 5/1-5/4 10 5 Panadol (500 mg)1# qid 2 5/7 0 4/30~5/4 5/1 9 5/2 5 4-4/26 4/29 33 5/3 103 6 13 2
97 5/4 5/1 - G2P2 5/4-5/4 - Gordon 103 6 13 2
98 4/26~5/4 1. 4/26 1,000~1,350 ml/day 700 ml/day 2. 4/26 10~20 3. 4/27 1. 4/26 24~28 X 2. 4/26 50 4/26 52 3 3. 4/26 125 mg/dl 13.61 mg/dl 5.1 meq/lhb10.5 g/dl X 4. 4/26 1. 4/29 20~22 2. 5/1 3. 5/4 1-1. 4/26 Lasix 40 mg IVP Q8H CXR 1-2. 1~4 1-3. 4/26 3 L/min 1-4. 30~40 2-1. 7 AM 103 6 13 2
99 2-2. 4/26 2-3. 4/27 2-4. 4/27 500~700 ml 1,500 ml 3~4 4/5 2-5. 4/27 1. 4/29 19~20 4/29 CXR 2. 5/1 3. 5/1 4/30~5/5 1. 4/29 33 2. 5/1 3. 5/2 5 4 1. 4/30~5/1 6~7 1~2 103 6 13 2
100 2. 5/1 9 3. 5/2 1. 5/2 2. 5/4 3 1-1. 5/2 1-2. 5/2 1-3. 5/2 5/2 5/2 (5/3) 5/3 2-1. 5/2 MP3 10 2-2. 5/3 103 6 13 2
101 3. 5/4 1. 5/2 2. 5/4 mp3 0 5/3~5/12 1. 5/3 2. 5/4 3. 5/4 1. 5/35/4 2. 5/4 10 3. 5/4 1. 5/5 2. 5/6 3. 5/13 103 6 13 2
102 1-1. 5/3 5/3 1-2. 5/3 1-3. 5/3 1-4. 5/4 1-5. 5/5 2-1. 5/6 1500 2-2. 5/11 3-1. 5/11 3-2. 1. 5/5 2. 5/6 100 3. 5/13 103 6 13 2
103 2011 5 29 6 5 20126 15 101 http://www.doh.gov.tw/ CHT2006/DM/DM2_2_po2. aspx?class_ no=440&now_fod_ list_no=10642&level_no=3&doc_ no=73104 20126 15 101 1 http://www.nhi.gov. tw/resource/webdata /21674_2_101 Q1-0730.pdf 2013 9 7 http://www.nhi.gov.tw/resource/ Webdata/24247_1_21. 102.07.29.pdf. 2012 11316-32 2008 7222-33 2008 103 6 13 2
104 7222-33 2007 18 159-67 2008 93-114 2011 10 211-23 2009 8218-27 2008 7 234-49 2008 7377-82 2000 47577-82doi: 10.6224/ JN.47.5.77 2010 223180-187 2009 10 131-41 2006 5 122-39 2011 106118-128 Clare, L. A. (2007). Psychological and physical care of malodorous fungating wounds. British Journal of Nursing, 16(15), 16-24. Holechek, M. J. (2004). Acute renal failure and chronic kidney disease. In S. M. Lewis, M. M. Heitkemper, & S. R. Dirksen (Eds.), Medical- Surgical Nursing (6th ed., pp. 1210-1246). St. Louis: Mosby. Rimmelé, T., & Kellum, J. (2010). Oliguria and fluid overload. Contributions to Nephrology, 164, 39-45. 103 6 13 2
105 Decision and Rebirth The Nursing Experience of Caring for A First-time Peritoneal Dialysis Patient Chia-Wan Chen Chia-Chi Kuo * Abstract This paper describes nursing care for an ESRD patient with rapid onset of end stage renal disease (ESRD) from long-term hypertension starting peritoneal dialysis for the first time. During the care period from April 26 to May 15, 2011, we assessed the patient using Gordon s functional health patterns and gathered information through physical examination, observation, interview, and review of medical records. Problems we identified included fluid overload, anxiety and body image disturbance. The patient s physical and emotional stress was caused by not being prepared for peritoneal dialysis before deciding to start treatment and difficulties in coping with the physiological and physical changes. Through listening, loving care, companionship, and empathy, we developed trust in the nurse patient relationship while also helping the patient with reducing anxiety and reacting positively to pressure. Along with the comprehensive care delivered by the multidisciplinary team of physicians and peritoneal dialysis nurses offering detailed information on the treatment and care, dieticians providing nutrition and diet advice, social workers extending psychological support and counseling as well as assistance from the support group and family members encouragement, the patient learnt to live with peritoneal dialysis, adapt to the changes with a positive attitude and returned to work successfully. Emotional care and support, a multidisciplinary team approach, and experience sharing from the support group are all critical when caring for patients undergoing peritoneal dialysis for the first time. By sharing this care strategy, we hope to improve the quality of peritoneal dialysis care. Key words: end-stage renal disease, peritoneal dialysis, fluid overload, anxiety, body image disturbance Nurse Practitioners, 9A Ward, Chi Mei Medical Hospital RN, MSN, Advanced Practice Nurse, Emergency Department, Chi-Mei Medical Center* Received: Aug. 1, 2013 Revised: Oct. 7, 2013 Accepted for publication: Nov. 4, 2013 Correspondence: Chia-Wan Chen No. 118-18, Yijhu, Yijhu Township, Chiayi County 62442, Taiwan (R.O.C.) Telephone: (06) 2812811 ext. 55901 E-mail: go6662@hotmail.com DOI: 10.3966/172674042014061302007 103 6 13 2