一位老年糖尿病患者足部外傷之護理經驗

Nursing Experience of Foot Trauma in a Case of Elderly Diabetic Patient

本文旨在探討一位65歲老先生因車禍導致左足踝內側撕裂傷而急診就醫，當日返家後在浴室跌倒導致左脛骨閉鎖性骨折入院手術。個案本身患有糖尿病，且車禍導致的足踝傷口組織壞死，將執行清創及植皮手術，個案擔心足踝傷口癒合不佳，若截肢將成為家人負擔，出現不安自責，身心皆受重大影響，此成為筆者選案的理由及探討的動機。護理期間自2017年6月30日至7月24日，運用Gordon 11項健康功能性型態做為評估工具，以會談、觀察、身體評估及病歷查閱方式進行整體性健康評估，確立個案主要的護理問題為：焦慮、急性疼痛及組織完整性受損。筆者於護理過程中提供個別性護理措施及手術前衛教，包括清創手術及分層皮膚移植手術前之準備事項、手術過程及術後傷口護理。透過主動關懷、傾聽及鼓勵個案表達內心感受，以降低個案的焦慮；為了緩解術後疼痛，於個案手術後主動評估疼痛程度，適時給予止痛劑及教導個案緩解疼痛之非藥物止痛措施。此外並教導個案傷口換藥、出院後傷口照護注意事項及血糖控制的重要性，建議可以安排糖尿病衛教師定期給予電訪並適時衛教，讓個案能獲得正確血糖控制之相關知識，以預防糖尿病的併發症發生。藉此協助個案接受手術，度過肢體創傷治療與復原的護理經驗分享，提供護理人員日後照顧此類患者之參考。 The purpose of this article is to investigatea 65-year-old patient who had emergencymedical treatment causing a medial lacerationof the left foot ankle due to a car accident.After returning home, he fell unconsciously inthe bathroom and he was admitted to a hospitalwith a closed fracture of the left sacrum. Inthe pass, this case suffered from diabetes andthe carotid wound tissue necrosis caused bythe car accident will carry out debridementand skin grafting surgery. The case worriesthat the wound healing is not good causingthe amputation will become the burden of thefamily and the self-blaming. Both body andmind will be greatly affected. This is the reasonfor the author's selection and motivation toexplore this case. During the period of nursingfrom June 30 to July 24, 2017, Gordon's11 health functional forms were used as anassessment tool, and overall health assessmentswere conducted to identify the main causesusing interviews, observations, physicalassessments, and medical records review. Thenursing problems are the anxiety, acute pain,and impaired tissue integrity.In the nursing process, the author appliedindividual nursing approaches and providedpre-operation education, including preparationsbefore debridement surgery and layered skingraft surgery, surgical procedures and postsurgerywound care. Through active caring,listening and encouraging the expression ofthe heart feelings, this can help to reduce hisanxiety. To relieve postoperative pain, authorassessed the degree of pain, gave analgesicstimely and educated the patient with nonpharmacologicalanalgesic methods. Authoralso educated the patient wound dressingmethods, the precautions of wound care afterdischarge from hospitals, and the importance oftaking into account the control of blood sugar.It is suggested that the diabetes educators canbe scheduled to give regular interviews andeducation timely, so that the patient can havethe relevant knowledge of correct glycemiccontrol to prevent complications of diabetes.It assisted this patient in the treatment andrecovery process of limb trauma, he can takecare of himself after returning home. Withsharing this nursing experience, it is hoped thatnursing staff will be able to provide care forsuch patients in the future.