協助一位糖尿病血液透析病患於截肢後學習自我照顧之護理經驗

Nursing Care Experience of a Diabetes Hemodialysis Patient Learning Post-amputation Self-care

本文為探討一位罹患糖尿病30年合併長期規則性血液透析治療的65歲女性病患，接受透析治療期間因左大拇趾傷口感染壞死，行左膝下截肢，加上雙眼因白內障，擔心失明，進而接受手術之歷程。筆者於2011年2月20日至2011年4月30日，運用Gordon十一項健康功能型態進行評估，經由家訪、直接照護、觀察、病歷查閱、會談、傾聽等方式收集資料，評估個案生理、心理、社會、靈性層面，確立個案照護期間有自我照顧能力缺失、潛在危險性跌倒及身體心像改變等護理問題。筆者藉由與個案建立良好的信任關係並主動關懷，在護理過程中，擬定個別性護理目標及適切之護理措施，針對自我照顧能力缺失，提供及指導復健技巧，訂定個案運動計劃，並多次與復健師討論復健運動計劃並適時做修訂，個案能達到部份自我照顧能力，並成功的預防個案在護理期間發生跌倒，期望本篇個案報告能提供未來照顧此類病患之照護參考。

The study is based on nursing experience with helping a long-term dialysis diabetes patient whose left leg was amputated below the knee after a toe infection turned septic and then underwent cataract surgery a short time later. Between February 20, 2011 and April 20, 2011, Gordon health's 11 functional health patterns were used to collect information through direct care, observation, medical records and interviews. Identified problems included deficiency in self-care ability, risk for falls and body image disturbance. The author established a positive relationship based on mutual trust and active care with the patient then defined personalized goals and treatments. For the deficiency in self-care ability, initiatives included guidance on rehabilitation techniques, set exercise programs and coordinating with the physical therapist on adjustments to the rehabilitation program. The patient eventually achieved a limited level of self-care ability and experienced no falls during the care period. This case report provides a useful reference for post-amputation care of long-term dialysis diabetes patients.