「糖」突危機～初診斷糖尿病合併酮酸血症病人之急診照護經驗

本文旨在分享照護一位初診斷糖尿病合併酮酸血症病人之急診護理經驗。照護期間為2019年9月13日至9月16日，藉由Gordon十一項功能性健康型態評估為架構，以身體評估、觀察、會談、查閱病歷等方式蒐集資料，確立個案健康問題依序為潛在危險性不穩定血糖濃度、增進健康管理的準備度、焦慮。個案因高血糖酮酸血症一度危及生命，急診治療準則以穩定血糖、矯正酮酸血症為優先照護目標，因應個案診斷初期難以接受罹患糖尿病與病危住院噩耗之焦慮，團隊以關懷、傾聽及引導式溝通，協助個案釐清與分析焦慮主因，鼓勵抒發感受與提供澄清、諮詢，並藉由示教與回覆示教幫助個案學習糖尿病自我照護，鼓勵與肯定引導個案正向面對疾病衝擊與激發健康管理的自信心，後續個案血糖控制穩定、焦慮改善、產生健康管理自信。臨床經驗發現初診斷糖尿病個案普遍有焦慮與健康管理之問題，影響急症初期照護，建議可透過引導式溝通，協助個案釐清與分析焦慮問題，以回覆示教、鼓勵與肯定激發個案健康管理的自信心與能力，協助個案正向面對「糖」突危機。

關鍵字

糖尿病酮酸血症；潛在危險性不穩定血糖濃度；增進健康管理的準備度；焦慮

並列摘要

This paper aims to share the experience of providing emergency nursing care to a newly diagnosed diabetic patient with ketoacidosis. The nursing period was from September 13 to 16, 2019, by applying Gordon's Eleven Functional Health Patterns Assessment; data were collected by physical assessment, observation, interviews, and review medical records. The health problems established included risk for unstable blood glucose level, readiness for enhanced health management, and anxiety. The case was once reaching life-threatening condition due to hyperglycemia ketoacidemia, and the emergency treatment guidelines were to stabilize blood sugar and correct ketoacidemia as the priority care goals, in response to the anxiety of suffering from diabetes and critical hospitalization in the early stage of diagnosis, the care team helped soothe the patient by caring, listening, and guided communication. The team also help the case clarify and analyze the main cause of anxiety, encourages the expression of feelings and provides clarification and consultation, and helps the case learn diabetes self-care through educating and responding, encouraging and affirming the positive direction of the case facing the impact of the disease and stimulating self-confidence in health management, subsequent cases have stabilized blood sugar control, improved anxiety, and developed self-confidence in health management. Clinical experience has revealed that newly diagnosed diabetes patients generally have anxiety and health management problems, which affect the initial-stage of emergency care. It is suggested that nurses can help soothe the patients through guided communication, and stimulate their confidence and ability in health management by responding to demonstration, encouragement, and affirmation. This will help the patients deal with the sudden crisis of "diabetes".

並列關鍵字

diabetic ketoacidosis ； risk for unstable blood glucose level ； readiness for enhanced health management ； anxiety

參考文獻

Romney, E., Nagaraj, V. J., & Kafer, A. (2016). A clinical case of clozapine induced fatal diabetic ketoacidosis. Clinical Medicine Insights: Psychiatry, 7, 1-5. https://doi.org/10.4137/CMPsy.S30532

吳淑芳（2014）．心理困擾之評估與處置；以糖尿病憂鬱為例．中華民國糖尿病衛教學會會訊，10(4)，11-17。https://doi.org/10.6583/TADE.2014.10(4).5

孫金梅（2019）．糖尿病病人合併憂鬱症或焦慮症長期趨勢、醫療資源耗用與醫療療效之探討．南臺灣醫學雜誌，15(2) ， 87-97 。https://doi.org/10.6726/MJST.201912_15(2).0003

謝芳傑、杜思德（2016）．成人第一型糖尿病的診斷陷阱：三病例報告．內科學誌，27(5)，274-279。https://doi.org/10.6314/JIMT.2016.27(5).07

Association of Diabetes Care and Education Specialists & Kolb, L. (2021). An effective model of diabetes care and education: The ADCES7 self-care behaviors™. The Science of Diabetes Self-Management and Care, 47(1), 30-53. https://doi.org/10.1177/0145721720978154

主題瀏覽