一位糖尿病足潰瘍面臨截肢病人之照護經驗

Care Experience of a Patient with a Diabetic Foot Ulcer Faced with Amputation

導致截肢。本文探討一位正值中年期面臨反覆糖尿病足感染，接受數次清創手術後，仍面臨截肢之照護經驗。護理期間由2016年1月19日至2016年1月26日，以Gordon十一項健康功能評估，藉由會談、觀察、實際照護、查閱病歷及溝通方式收集資料，針對個案有無效性自我健康管理、急性疼痛及身體心像改變三項護理問題進行討論。照護期間利用護理專業知識結合跨團隊資源，教導個案正確胰島素注射及飲食指導，提升個案對糖尿病自我管理認知及自我照護行為，有效的執行自我健康管理。配合止痛藥物使用，協助個案彈繃加壓、冰敷減少患肢腫脹；藉由轉移注意力、按摩及電療等非藥物輔助療法，緩解其疼痛問題。與個案共同策劃復健運動增強肌力，教導使用助行器及肢體移位方式，提升自我照顧能力，並提供輔具之社會資源，幫助個案日常生活活動便利；運用傾聽、鼓勵及同理心，引導個案表達截肢後感受，漸進式引導個案正視傷口並參與照護，給予個案心理支持，協助個案心理調適，正向接受身體改變並面對疾病，提升生活品質。（澄清醫護管理雜誌2019；15（3）：45-53） Diabetic foot infection is the most common complication of diabetes, resulting in amputation in severe cases. This article reports the care experience of a middle-aged patient with repeated diabetic foot infections who required amputation after several debridement operations. During the care period from January 19, 2016 to January 26, 2016, Gordon's 11 functional health patterns were used to collect data through interviews, observation, actual care, and review of medical records and communication. The three care issues of ineffective self-health management, acute pain, and physical and mental changes were discussed. During the care period, professional care knowledge combined with cross-team resources were used to instruct the patient on correct insulin injections, to provide dietary guidance, to enhance the patient's awareness of diabetes self-management and self-care behaviors, and to effectively implement self-health management. Combined with the use of analgesic drugs, pressure and an ice compress were used to reduce swelling in the affected limb of the patient. Non-drug adjuvant therapies, such as diversion of attention, massage, and electrotherapy, were used to relieve pain. Rehabilitation exercises were jointly planned with the patient for enhancing muscle strength, and the patient was taught about the use of walking aids and about types of limb movements, improving the patient's self-care ability. In addition, social resources for assistive devices were provided to help facilitate the patient's daily-life activities. With listening, encouragement, and empathy, the patient was guided to express feelings after amputation; gradually, the patient was guided to confront the wound and participate in its care. Psychological support was also provided to assist in psychological adjustment, so that the patient could positively accept the physical changes and face the condition, resulting in improvement of quality of life. (Cheng Ching Medical Journal 2019; 15(3): 45-53)