運用慢性照護模式於長期血糖控制不佳個案之加護經驗

Applying chronic care model in caring a patient with type 2diabetes mellitus and hyperglycemic hyperosmolar state

林艷霞(Yen-Hsia Lin) ； 陳繪竹(Hui-Zhu Chen) ； 刁綺慧(Chi-Hui Tiao) ； 鄭雅方(Ya-Fang Cheng)

《安泰醫護雜誌》 25卷2期 (2019/12) Pp. 79-91

摘要

本文為一位70歲男性罹患第二型糖尿病併發高血糖高滲透壓狀態入加護病房之照護經驗，護理期間為2016年10月20日至10月26日。筆者於照護期間透過生理、心理、社會和靈性之整體性評估，藉由開放性會談、觀察、身體評估及臨床照護彙整資料後，確立個案有高血糖高滲透壓狀態的現存性傷害、皮膚完整性受損及知識缺失：缺乏正確的飲食控制、運動及藥物知識等健康問題。照護期間運用傾聽、主動關懷，鼓勵個案說出心中感受，了解其拒絕使用胰島素之原因，進而提供正確的用藥知識，透過跨領域團隊協助個案將飲食控制及運動落實於生活中，利用口頭教導、回覆示教，提升個案對足部傷口的照護及胰島素注射的技能，增強糖尿病病人返家後自我照顧能力，藉以提升病人的生活品質。

關鍵字

高血糖高滲透壓狀態 ； 胰島素 ； 糖尿病足居家照護 ； 慢性照護模式

並列摘要

This case report presents an unique nursing care experience of a 72 years old male patient suffering from a serious complication ＂Hyperglycemia Hyperosmolarity State＂ caused by his previous disease, Type 2 Diabetes Mellitus. Over the period from Oct. 20th to Oct. 26th, 2016, the author collected Physical, Psychological, Social and Spiritual information through asking open questions, observation and physical examination to address this patient's health problems which were defined as the existent damage resulting from H.H.S., Impaired skin integrity and Knowledge deficiency in correct diet intake, daily exercise and sugar controlling medicine. In the caring process, we exerted the way through listening, active caring and encouraging him to share and express his feelings to understand the reason why he refused to take the insulin medicine. For the purpose of promoting his daily life quality, we supplied the rectified instruction of medicine, cooperated with other discipline specialists to control his diet intake and to impose the exercise in daily life, and used oral education and feedback demonstration to advance both the care of foot wound and the skill of injecting insulin which improved the self care ability when his returning to ordinary life.

並列關鍵字

Hyperosmolar Hperglycemia State ； Insulin ； Diabetic foot home care ； Chronic care model