62 * ** *** 2010 3 20 2010 6 5 2010 2010 28.22 Yang, Hwang, & Taiwan Society of Nephrology, 2008 2006 2008 * ** *** 100 7 4 100 8 18 100 9 13 34 02 26318652 3152 sheu@hk.edu.tw 101 12 11 4
63 : 2008 3.5 g/dl 2007 Rammohan, Kalantar- Zadeh, Liang, & Ghossein, 2005 1. 0.6~1.5 // 50 2. 35 //Bailey & Franch, 20093. 700~1,000 cc/ 0.5~1 Fincham & Moosa, 2008 3.3 g/dl 2007 11~12 g/ dl Hct 33~36 2009 BMI npna 1.2 gm/day/kg 2006 Cano, 20072006 : Kt/V 1.2 2009 2008 2006 Mc Clellan, 2001 2008 2008 2007 101 12 11 4
64 2006 2009 2006 2008 2006 2008 48 73 18 16 18 19 4,000 2000 2010 3 2010 2 26 BUN 132 mg/dl Cr 9.16 mg/dl Hb 8.3 g/dl HbA1c 7.0Albumin 2.3 g/dl Hct 24.9 X 3 1 38.1 3 8 3 16 perm cath 3 18 2010 3 20 6 5 3 16 101 12 11 4
65 150 44 48 [(150 70) 0.6 48] BMI 19.5 kg/m 2 20~25 kg/m 2 500 cc/ 1,680 48 Kg 35 Cal/Kg 1,680 Cal 1,200~1,300 3/20 2.6 g/dlnpna 0.9 gm/ day/kg25.0 Kt/V 0.9 108 mg/dlp3.2 mg/dl 14~16 200~300 cc 1.0~1.5 X /CTR 0.49 0.5 0.1 : 102~110/58~62 mmhg 128~136/84~96 5~10 101 12 11 4
66 : / / / 101 12 11 4
67 /3/20~6/5 4/6 1 5 0 0 28 2.8 g/ dl Kt/V > 1.2 3/20 S1 S2 S3 O1 1 5 0 48 44 BMI 19.5 kg/ m2 O2 1,680 / 1,200 O3 2. 6 g / d l 3/20P 3.2 mg/dl 108 mg/dl npna 0.9 gm/day/kg Kt/V 0.9 O4 25.0% 500cc O 5 : Darbepoetin alfa( EPO) 25 mcg 5/4 3.0 g / d l n P N A > 1.1 gm/day/ kg 3 0 6/5 3.3 g/dl npna > 1.2 gm/da-y/ kg 33 1. URR Kt/V 2. 3/20 3. 4. 237 cc = 475 5. 6. 7. 8. 9. 4/6 Kt/V 1.3 1,760 / 66 / 4/6 2.8 g/ dl 28 117 mg/ d 4.0 mg/ dl 44.3 BMI 19.6 kg/m 2 5/4 Kt/V 1.3 3.1 g/dl npna 1.2 gm/day/ kg 30 126 mg/ dl 6/5 3.3 g/ dl npna 1.3 gm/ day/kg Kt/V 1. 3 126 mg/dl 33 101 12 11 4
68 / 3/25~5/5 S1 S2 S3 O1 O2 4/1 5/5 1. 4/1 2. 3. 5/5 4. 100 5. ( ) 6. 101 12 11 4
69 / 4/25~6/5 S1 5/1 1. 5/1 6/5 2. 6/5 S2 3. 4. O1 4/25 5. 101 12 11 4
70 Kt/V 1.3 20092008 Kt/V 2007 11 6662-667 2010 6 3 98 2010 6 3 http://www.doh.gov.tw/ /98 /98 2007 6 147-59 2008 101 12 11 4
71 7 160-72 2006 5 260-78 2006 5 1 67-77 2006 11 23-9 2006 5 154-65 2009 8 11-12 2006 5 11-11 2008 7 146-59 2009 21 2109-112 Bailey, J. L., & Franch, H. A. (2009). Getting to the meat of the matter: Beyond protein supplementation in maintenance dialysis. Seminars in Dialysis, 22(5), 512-518. Cano, N. (2007). Nutritional supplementation in adult patients on hemodialysis. Journal of Renal Nutrtion, 17(1), 103-105. Fincham, D. & Moosa, M. R. (2008). Dietary and fluid adherence among heamodialysis patients attending public sector hospitals in the western cape. South African Journal of Clinical Nutrition, 21(2), 7-12. McClellan, M. J. (2001). Emotional trauma associated with renal disease and natural disasters. Nephrology Nursing Journal, 28(5), 529-536. Rammohan, M., Kalantar-Zadeh, K., Liang, A., & Ghoossein, C. (2005). Megestrol acetate in a moderate dose for the treatment of malnutritioninflammation complex in maintenance dialysis patients. Journal of Renal Nutrition, 15, 345-355. Yang, W. C., Hwang, S. J. & Taiwan Society of Nephrology (2008). Incidence, prevalence and mortality trends of dialysis end-stage renal disease in Taiwan from 1990 to 2001: The impact of national health insurance. Nephrology Dial Transplant, 23(12), 3977-3982. 101 12 11 4
72 Experience with Caring for a Patient with Diabetic Nephropathy Undergoing Hemodialysis Hui-Chu Chan Hsiu-Yu Sung* Shu-Hui Chiu** Jyh-Dar Liou*** Abstract The subject of this report was a diabetic patient with multiple complications that received guidance on coping with the physiological, psychological and social problems encountered during hemodialysis. During the care period between March 20, 2010 and June 5, 2010, data was collected through interviews, physical examination, chart reviews, patient records, family visits and dialysis records. The data was analyzed to identify the subject's chief health problems: Imbalanced nutrition: less than body reguiremants, situational low self-esteem and need for family process. During the care process, the author leveraged the resources of social workers and private organizations to reduce the pressure on the subject's family by providing economic assistance, housekeeping services as well as teaching the patient the skills needed for self-sufficiency. By encouraging the subject to think positively and acknowledge the subject's own contributions, total care was achieved through reducing situational low self-esteem, putting the subject s family situation back in order and improving the subject s quality of life. Key words: diabetic nephropathy, hemodialysis, care experience RN, MSN, HemoDialysis Room, Changhua Christian Hospital Lukang Branch RN, MSN, Lecturer, School of Nursing, University of HungKuang* RN, MSN, Director, Department of Nursing, Changhua Christian Hospital Lukang Branch** Bachelor,Director, Department of Nephrology, Changhua Christian Hospital Lukang Branch*** Received Jul. 4, 2011 Revised Aug. 18, 2011 Accepted for publication Sep. 13, 2011 Correspondence Hsiu-Yu Sung, No. 34, Chung-Chie Rd., Shalu, Taichung 43302,Taiwan, ROC. Telephone04 26318652 ext.3152 E-mail sheu@hk.edu.tw 101 12 11 4