一位糖尿病患者四肢燒傷之護理經驗

A Nursing Experience of Limb Burns in a Diabetic Patient

孫權宇(Chuan-Yu Sun) ； 莊文怡(Wen-Yi Chuang)

《新臺北護理期刊》 22卷2期 (2020/09) Pp. 99-108

https://doi.org/10.6540/NTJN.202009_22(2).0009

摘要

本篇個案報告描述一位四肢燒傷的糖尿病患者，於2017年6月21日至7月20日於燒傷加護中心住院期間之護理經驗，個案因罹患糖尿病，且住院前血糖控制不佳，可能影響燒傷傷口之癒合。筆者運用同理、關懷、支持及接受等技巧，透過直接的傷口照護，與個案建立良好護病關係及收集資料，並以Gordon十一項功能性健康型態評估，發現個案之主要護理問題有：皮膚完整性受損、焦慮、活動功能障礙及知識缺失等四項主要健康問題。針對個案之護理問題給予適當之護理措施如：良好無菌換藥及感染控制、鼓勵個案表達情緒及困難、提供手術及傷口照護衛教、協助物理治療並衛教漸進式活動方法及教導糖尿病發生原因、控制血糖重要性及正確飲食攝取等，以幫助個案之護理問題獲得改善。護理人員在臨床照護上除傷口護理外，更需敏銳察覺個案對於糖尿病知識不足，可能為影響傷口癒合之因素，應協助給予正確觀念及指導，期望藉此護理經驗可提供日後臨床護理人員在照護燒傷合併糖尿病患者時，能有所依循，並能針對護理問題規劃適當之護理措施，以提升病患生、心理之舒適。

關鍵字

四肢燒傷 ； 焦慮 ； 糖尿病

並列摘要

This case report describes a nursing experience of a diabetic patient with limb burns during the hospital stay in a Burn Center from June 21^(st) to July 20^(th), 2017. The healing of the patient's burn wound may be affected by diabetes and poor glycemic control before hospitalization. By using the techniques of expressing empathy, care, support, and acceptance, the author established a good relationship with the patient and collected information through direct wound care. Based on Gordon 11 Function Health Patterns, four of the patient's major health problems were identified: impaired skin, anxiety, activity dysfunction, and lack of knowledge. Appropriate care measures were provided to help improve the patient's health problems, including giving good sterile dressing change and infection control, encouraging the patient to express emotions and difficulties, providing surgery and wound care education, assisting in physical therapy and teaching progressive exercise, and teaching the causes of diabetes, the importance of blood sugar control and proper dietary intake. It is suggested that in addition to wound care, the nursing staff should be aware of whether patients have enough knowledge on diabetes and its effect on wound healing, and assist in giving correct concepts and guidance. It is hoped that this nursing experience will provide a better understanding for clinical nursing staff on caring burn patients with diabetes, giving appropriate nursing measures according to the patients' nursing problems to improve their health and psychological comfort.

並列關鍵字

limb burns ； anxiety ； diabetes

參考文獻

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衛生福利部（2017）‧105年死因統計結果分析‧取自http://dep.mohw.gov.tw/DOS/cp-3352-33576-113.html