從醫院到社區照顧一位年輕女性罹患代謝症候群之護理經驗

From Hospital to Community: Nursing Experience of Caring for a Young Woman with Metabolic Syndrome

本文敘述一位代謝症候群合併肥胖的年輕女性，因對疾病認知不足及攝取過多熱量、缺乏運動，個案面對自身身體心像改變，使得負面的自我評價，產生情緒低落及羞愧情形。照護期間為2020年03月25日至05月30日，以Gordon十一項健康功能型態評估，藉由面談、觀察、電訪、身體評估等收集資料，確立四個主要健康問題：健康維護能力改變、營養不均衡多於身體需要、活動少於身體所需及長期性低自尊。依個案對代謝症候群知識不足，運用手冊及QR code衛教疾病知識與自我照顧的技巧，也因攝取高熱量飲食、無運動習慣而產生肥胖體位，透過規律測量體重、腰圍、血壓，訂定個人的健康飲食方案、運動計劃，並以生活日誌紀錄每日食物熱量、運動量，連續八週修正飲食及運動行為，監控個案熱量攝取與消耗量；個案面臨身型肥胖導致自我身體心像認同不足與同儕疏離，累積負向情緒而出現低自尊狀態，運用同理心、傾聽、主動關懷，了解個案偏好使用的社交平台，由臉書發佈激勵話語及減重成功案例心得，引導重新建立信心並從旁支持，以培養自我價值感。代謝症候群已被視為心血管、糖尿病之高危險群，護理人員除了具備慢性病照護觀念外，建議可篩選出此類高危險群，加強個案管理，如：安排定期追蹤飲食、運動及體重的變化，幫助成年肥胖者漸進式的養成健康生活型態。因此，護理人員應將體位控制納入照護計畫中，建立支持性群組和獎勵機制，以增強健康自主管理的延續性。期望透過此案例的分享，提高重視對代謝症候群的警訊，未來提供護理人員照護社區個案之參考。

This paper describes the nursing experience of caring for a young woman with metabolic syndrome and obesity, who struggled with a poor body image, negative self-evaluation, depression, and feelings of shame due to a lack of awareness about her disease, excessive caloric intake, and sedentary lifestyle. From March 25 to May 30, 2020, data was collected through various methods, and four major health problems were identified: altered health maintenance capacity, nutritional imbalance, inadequate physical activity, and chronic low self-esteem. To address these issues, the patient received health education on disease knowledge and self-care, guidance on monitoring nutritional intake and caloric consumption, and support in rebuilding her confidence and developing a sense of self-worth through empathy, listening, and motivational messages. The patient was also encouraged to adopt a healthy and balanced diet, exercise plan, and record her progress in a life diary. This case highlights the importance of screening high-risk groups for metabolic syndrome, strengthening case management, and incorporating postural control, supportive groups, and reward mechanisms into care plans to promote autonomous health management and prevent cardiovascular disease and diabetes.