- 期刊
應用個案管理於糖尿病腎病變患者之護理經驗
A Case Manager's Nursing Experiences of an Initial Diagnosis of Diabetic Nephropathy Patient
摘要
本文旨在應用個案管理師角色功能照護一位初次診斷糖尿病腎病變患者之護理經驗，護理期間自2018年9月1日至2018年12月5日，運用Gordon十一項健康功能型態進行評估，並利用會談、觀察、身體評估及查閱病歷方式收集個案健康資料，確立個案主要的健康問題為知識缺失、潛在危險性腎臟灌流失效、焦慮。筆者於護理過程中運用傾聽、陪伴、同理心及鼓勵個案表達內心感受，建立夥伴及良好信任關係，應用遠距照護服務模式，提供個別性、連續性、即時性的專業諮詢與照護，教導及澄清正確的胰島素注射知識與技能、血糖監測原則及低血糖處理方式，收案三個月後個案已能清楚說出糖尿病腎病變與血糖控制的重要性，且能正確操作胰島素注射、控制尿蛋白、糖化血色素由9.2%降至7.2%及巨量白蛋白尿13,014mg降至9,107mg，延緩腎功能惡化，同時也降低個案對疾病的焦慮程度，使個案能主動學習自我照顧，正向面對與疾病共存，恢復獨立生活功能，期望此護理經驗可作為日後照護此類個案之參酌。
並列摘要
This article describes the case manager's experience for an initial diagnosis diabetic nephropathy patient. The nursing care period was from September 1 to December 5, 2018. The Gordon 11 Functional Health Pattern guidelines were applied for assessment and health data were collected through interview, observations, physical examination, and chart review. The major health problems of patient were diagnosed were deficit knowledge, risk for ineffective renal perfusion, and anxiety. During the nursing process, the author applied the skills of listening, companionship, empathy and hence encouraged expression of inner feelings. The author established partnerships and a good trusting relationship, and made use of telecare models to provide individualized, continuous and real -time counseling and care. For the purpose of teaching and clarify correct knowledge of skills towards insulin's injection, principles of blood sugar monitor, and how to deal with hypoglycemia. After three months of care, the patient clearly stated the importance of diabetic nephropathy, blood sugar control, performed the procedures of insulin's injection correctly, and well controlled glycosylated hemoglobin (9.2% fell to 7.2%), macroalbuminuria (13014mg dropped to 9107mg) to retard the deterioration of renal function, and thus reduced degree of anxiety for the illness. Ultimately, the patient initiated self -caring; was able to face and coexist with the disease, and restore the function of independent livelihood. This nursing experience can be used as a reference with nurses who were caring similar patients in the future.