臨牀透析 Vol.30 No.12(2-2)


特集名 体重管理が困難な透析患者への支援
題名 体重管理困難事例への看護の挑戦!―個別性に応じた看護ケア― (2) 自己管理見直し入院を契機として体液管理ができるようになった事例
発刊年月 2014年 10月
著者 井上 智恵 近江八幡市立総合医療センター看護部・看護師(慢性疾患看護専門看護師)
著者 北村 美也子 近江八幡市立総合医療センター看護部・看護師(当時)
著者 原 将之 京都府立医科大学腎臓内科
著者 薗村 和宏 近江八幡市立総合医療センター腎臓内科
著者 八田 告 近江八幡市立総合医療センター看護部・看護師(慢性疾患看護専門看護師)/八田内科医院
【 要旨 】 透析患者にとって体液過剰は心血管系の負担となる.体液過剰は食塩と水分の過剰摂取により生じるが,当院では減塩指導を主とした体液管理を行っている.今回,自己管理見直し入院をきっかけに体液過剰の患者が体液管理を行えるようになった事例を経験した.塩分味覚の低下や食塩摂取と体重の変化を視覚的に説明し,丁寧に食生活を振り返ったことで,食塩摂取過多の食生活を実感することができた.食塩摂取量が管理されたなかで透析の不快感が消失したことは,減塩継続の動機づけとなった.自己管理見直し入院を効果的に活用するためには,入院前に療養生活に対する動機づけを高めておくことが重要である.
Theme Nursing care for dialysis patients having difficulty in body weight control
Title Hospitalization for self management review improve fluid management of dialysis patient : A case
Author Tomoe Inoue Department of Nursing, Omihachiman Community Medical Center
Author Miyako Kitamura Department of Nursing, Omihachiman Community Medical Center
Author Masayuki Hara Department of Nephrology, Omihachiman Community Medical Center
Author Kazuhiro Sonomura Department of Nephrology, Omihachiman Community Medical Center
Author Tsuguru Hatta Departmant of Nephrology, Kyoto Prefectural University School of Medicine / Hatta Medical Clinic
[ Summary ] Hypervolemia, which is caused by excess salt and water levels in the body, places a burden on the cardiovascular system of dialysis patients. In our hospital, we conduct fluid management programs which mainly focus on instructing patients to decrease their salt intake. We treated patients with hypervolemia who were instructed on fluid management after hospitalization to enable a review of their self management. Patients were provided with visual illustrations explaining insensitivity to perception of salt, salt intake, and changes in body weight. Their diets were also carefully reviewed. This enabled patients to realize their diets include excessive salt. With a decrease in salt intake, they stopped experiencing discomfort during dialysis that accompanied their salt intake management. This gave patients additional motivation to continue decreasing their salt intake. In order to effectively utilize hospitalization with the aim of helping patients review their self-management, it is important to increase patient motivation in regard to their recuperative lifestyle prior to hospitalization.
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