一位糖尿病血液透析患者合併高血糖及高血鉀症之護理經驗

Patient with High Blood Sugar and Hyperkalemia caused by Diabetes Blood Dialysis: A Case Report

韓湘芳(Hsiang-Fan Han) ； 鍾玉珠(Yu-Chu Chun) ； 陳意超(Yi-Chao Chen)

《彰化護理》 22卷4期 (2015/12) Pp. 30-42

https://doi.org/10.6647/CN.22.04.11

摘要

本篇旨在探討照護一位糖尿病血液透析患者，因血糖控制不良導致其併發高血糖及高血鉀症住院治療，面臨身體不適及心理困擾之護理經驗。筆者為透析室護理師，自個案急症入加護室至穩定轉入普通病房、再出院至門診持續透析為止全程追蹤、評估及照護，總計護理期間為2013年3月30日至4月18日，運用Gordon十頂健康功能型態進行護理評估，透過觀察、傾聽、訪談、身體評估及查閱病歷等技巧收集資料，確立個案之主要健康問題為高危險性損傷、無效性健康維護能力及無力感。個案因透析合併高血糖及高血鉀症急性併證症反覆性入院，筆者在照護期間主動關心個案促其表達內心感受，配合膜島素及降血鉀藥物治療，並提供糖尿病、限鉀飲食、運動衛教及主動聯絡營養師共同設計專屬個案之飲食計畫，個案之血糖值由1012 mg/dl下降至248 mg/dl 、血鉀值由7.5 mEq/L下降至3.6 mEq/L，個案並在出院返家後能持續性監測血糖及調整飲食型態並規律運動，透過醫療團隊合作及家庭支持系統的發揮，提升自我照顧知識及技巧，減輕個案之焦慮、無助及增進自我控制感，進而正向面對疾病變化與疾病共存。冀望此護理經驗能提供血液透析護理同仁照顧此類個案之參酌。

關鍵字

血液透析 ； 高血糖 ； 高血鉀症 ； 高危險性損傷 ； 無力感

並列摘要

We shared the nursing experience of a diabetes patient with hyperglycemia and hyperkalemia due to poor control of blood sugar cause to psychological and physical problems. Nursing period was from March 30th 2013 to April 18th. We used Gordon's 11 Functional Patterns to evaluate through observation, listening, interviewing, physic al assessment and chart reviewing then confirmed the nursing problems of high risk of injury, invalid health maintenance and powerless. We actively paid our highly care to this patient during the period of treatment. Finally, the patients' blood sugar and potassium decreased from 1012 mg/dl to 248 mg/dl and 7. 5 mEq/L to 3.6 mEq/L, respectively. With a meal plan especially for diabetes patients, regular exercise, and consulting a dietitian, the patient could adjust the dieting issues and did regular exercise; furthermore, he monitered his blood sugar persistently after discharging from the hospital. We upgraded patient's self-controlees and changed his anxiety and helpless to be more positive of the illnesses and provided this case study to nursing staff as reference who face to the same cases.

並列關鍵字

Diabetic Dialysis ； Hyperglycemia,Hyperkalemia ； High risk of injury ； Powerless

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