一位糖尿病足併發周邊動脈阻塞性疾病病患之護理經驗

The Nursing Experience of Caring a Patient with Diabetic Foot and Peripheral Arterial Occlusive Disease

何婉綾(Wan-Ling He) ； 曾瓊誼(Chun-Yi Tseng)

《長庚護理》 28卷3期 (2017/09) Pp. 528-538

https://doi.org/10.3966/102673012017092803013

摘要

本文描述一位糖尿病足併發周邊動脈阻塞性疾病病患之護理經驗，病患因傷口反覆性感染及患肢出現酸麻感，故再度行清創手術，照護期間自2014 年10 月3 日至2014 年10 月29 日，經由觀察、直接照護、會談、傾聽、病歷查閱等方式收集資料，並運用Gordon 十一項功能性健康型態進行評估，收集主、客觀資料確立病患有急性疼痛、組織灌流改變：週邊、危險性感染、焦慮等健康問題。照護期間藉由家屬的關心與支持，建立良好護病關係，教導病患及家屬運用放鬆技巧及心理支持減輕疼痛不適，並以肢體保暖及按摩方式，促進血循順暢，以改善末梢冰冷及痠麻情形，透過認識傷口感染表徵，預防感染持續惡化，對於傷口照護要維持傷口清潔，並教導病患和家屬換藥技巧，換藥前可採腹式呼吸法，以緩解病患焦慮。藉由醫療團隊及中西醫共同照護，採遠紅外線照射療法及針灸治療，促進傷口癒合，以讓病患增強復原信心，並學習面對疾病，順利出院返家。希望藉此文獻探討及護理經驗的分享，作為臨床護理人員照顧類似病患之參考。

關鍵字

糖尿病足 ； 周邊動脈阻塞性疾病 ； 護理經驗

並列摘要

This paper illustrates the nursing experience of caring a patient with diabetic foot complicated with peripheral arterial occlusive disease. Due to repeated wounds infections and tingling sensation over affected extremity, once again debridement surgery was performed. During the period from October 3 to 29 in 2014, data was collected by observation, direct care, interview, listening, and review of medical records. After data analysis, the nurse assessed the patient with Gordon 11 Functional Health Status Assessment tool and collected subjective and objective data to establish patient who have acute pain, changes in tissue perfusion: peripheral, high risk of infection, and anxiety. During the nursing process, under family care and support, good treatment relationship was established. We educated patient and their family members about relax skills and psychological support to release patient's discomfort. Before changing dressing, we let the patient breathe by abdominal breathing for anxiety relief. By recognizing the wound infections sign, we prevented the condition of infection exacerbated. Besides, we kept the wound clean by wound care and educated the patient and family members about skills of changing dressing. Under combinational therapy of TCM far-infrared radiation therapy with acupuncture therapy for wound healing, the patient was confident in recovery and being discharged soon. We hope to share this nursing experience for future references.

並列關鍵字

diabetic foot ； peripheral arterial occlusive disease ； nursing experience

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