一位糖尿病酮酸中毒患者於急診之護理經驗

A Nursing Experience for a Patient with Diabetic Ketoacidosis

本文是一位21歲男性因糖尿病酮酸中毒於急診室求診之護理經驗。個案自7歲時即診斷罹患第一型糖尿病，長期注射胰島素控制血糖，自父母離異後，無母督促，咸少回門診追蹤，此次因呼吸急促及嗜睡，經家屬緊急送至急診就醫。於病史中發現自98年起共有4次因血糖控制不良合併酮酸中毒而住院治療，故運用Orem自我照顧護理理論為評估架構，透過觀察、身體評估、會談進行資料收集與分析，確立個案生理方面有「體液容積缺失」、心理社會層面有「無效性自我健康管理」及「家庭運作過程紊亂」之護理問題。筆者除執行緊急醫療措施，協助穩定病情，改善不適，亦運用在急診有限護理期間發揮護理獨特性功能，藉由良好治療性溝通，透過主動關懷、傾聽及鼓勵家庭成員彼此溝通，教導個案及家屬有關之照護技能，提供預防酮酸中毒及控制血糖方法等個別性護理衛教。使個案於急性期身、心、靈達到正向適應，亦使個案能夠增強對健康的信念，增進個案的健康管理行為。筆者將此個案護理經驗提出分享，盼能做為日後照護類似個案參考。

This report describes the nursing experience for a 21-year-old patient admitted to the emergency department of an acute hospital for diabetic ketoacidosis. This patient had been receiving insulin injections for blood sugar control since he was diagnosed with type I diabetes at the age of seven. Without experiencing much specialized attention for monitoring blood sugar levels, the patient rarely returned to the clinic for follow-ups. The patient was sent for emergent care by the family when he was found in deep sleep with rapid respiration. The patient had experienced four bouts of hospitalization for ketoacidosis in the past. Orem's self-care theory was used as the assessment structure. By means of observation, interview, and physical examination, the author collected and analyzed the resulting data. The three nursing problems that were identified were loss of body fluid, ineffectiveness of self management of health, and disorder of the family operational process. In addition to performing emergent measures, assisting in stabilization of medical condition, and improving discomfort, the author developed unique nursing functions during a short period of time in the emergency department. Through good therapeutic communication, such as active listening and caring, the family members were encouraged to communicate with each other. The patient and family were taught about self care for the prevention of ketoacidosis. Moreover, the patient learned how to adapt in physical, psychological, and spiritual aspects, which reinforced healthy beliefs and behavior in health management. This paper shares the author's experience, and it can be used as a reference for other nurses caring for similar cases in the future.