一位第一型糖尿病酮酸中毒幼兒之護理經驗

A Nursing Experience of A Child With Type I Diabetes Mellitus Complicated with Ketoacidosis

本文為第一型糖尿病酮酸中毒幼兒護理經驗，此個案是初次診斷，對個案及家屬身心衝擊相當大，希望藉由個別性照顧，協助個案及照顧者能接受疾病事實及學習複雜照顧問題。護理期間為2018年9月20日至9月25日，運用Gordon十一項健康型態功能評估，以直接照護、觀察、病歷查閱及會談等方式收集資料，確立個案有體液電解質失衡、危險性不穩定血糖濃度、焦慮及照顧者角色緊張等護理問題。照護期間評估個案需求提供個別性護理措施，依據糖尿病治療準則，即時處置、密切監控電解質檢驗及記錄輸出入量，維持電解質平衡及穩定血糖，依幼兒發展認知特質，運用治療性遊戲與個案建立良好護病關係，減少對治療處置及陌生環境產生的焦慮與害怕，主動關懷、陪伴、傾聽及溝通等方式與主要照顧者建立良好的信任關係，指導照顧知識與技巧，安排示教實際操作及鼓勵參與照護，提供疾病相關資訊與教導尋找糖尿病相關社群網路資源，協助家屬了解疾病特性及照護重點，緩解緊張焦慮情緒，藉此照顧經驗建議院方能強化幼兒治療性遊戲運用的訓練及設計影音衛教系統，讓護理人員能提供更友善及有效率照顧，以此經驗提供給照顧此類患者之護理人員參考。

This study aims to share a nursing care experience of a child with Type I Diabetes Mellitus complicated with Ketoacidosis from September 20 to 25, 2018.The Gordon's 11 Functional Health Patterns was conducted, and data were collected by direct care, observation, medical record review and interviews. Nursing problems included fluid and electrolyte imbalance, unstable blood glucose concentration, anxiety and care-giver role strain.Individualized nursing care was provided based on diabetes guideline to monitor the electrolyte and intake/output record, maintain electrolyte balance and stabilize blood glucose. Therapeutic play was conducted to establish good patient-nurse relationship to reduce anxiety and fear for the treatment and environment. Mutual trust was built between the nursing professional and care-giver by active care, listening and good communication. Caring knowledge and skills were instructed, practical operations were arranged, and caregivers were encouraged to participate in caring. Disease information were provided, and care-givers were instructed to search related information on websites. It is suggested that the use of therapeutic play and audiovisual education system can be strengthened, so the nursing professionals are able to provide friendly and effective nursing care. It is expected that this study provides clinical experience to whose who work with clients with Type 1 Diabetes Mellitus complicated with Ketoacidosis.