一位肥胖青少年面對第二型糖尿病治療之照護經驗

Experience of Nursing Care for an Adolescent with Obesity and Type 2 Diabetes

10.6142/VGHN.202106_38(2).0011

林美秀(Mei-Hsiu Lin)；陳淑娟(Shu-Chuan Chen)；黃雅慧(Ya-Hui Huang)

第二型糖尿病 ； 肥胖 ； 青少年 ； Type 2 diabetes ； obesity ； adolescents

榮總護理

38卷2期（2021 / 06 / 01）

203 - 211

繁體中文

本文描述一位肥胖青少年面對第二型糖尿病治療的照護經驗。於2018年6月18日至22日護理期間，透過直接照護、觀察、會談及運用Gordon十一項功能性健康型態進行整體性評估，確立病人主要健康問題有無效性健康維護能力、營養不均衡：多於身體需要、增進家庭因應能力的準備度等，以主動關懷、同理心、尊重技巧建立信任治療性關係，運用網路資源，結合糖尿病衛教師、營養師等跨團隊，強化病人和家屬對疾病照護的認知，共同擬定飲食、運動與體重管理計畫，學習食物熱量代換表，將同為糖尿病人的母親納入共同照護對象，賦予協同照護的責任，並模擬返家後面臨飲食問題激發病人思考，提升其自我照顧動機與能力。建議照護此族群之第二型糖尿病，應落實自我管理計畫網絡之建構，讓醫院—家庭—學校接軌，期望藉由分享此護理經驗，提供臨床照護參考。

This article reports the nursing experience of caring for an adolescent aged 13 years with obesity and type 2 diabetes from June 18 to 22, 2018. During physical assessments, observations, and interviews, Gordon's 11 functional health patterns assessment was applied to assess the patient, and the following unaddressed problems were identified: ineffective health maintenance, imbalanced nutrition due to overeating, and a need for enhanced family coping strategies. To treat the patient, care providers first aimed to do the following: (1) establish a trusting therapeutic relationship through active care, empathy, and respect; (2) integrate multidisciplinary teams involving diabetes educators and dieticians; and (3) apply online resources to heighten the awareness of diabetes in the patient and their family members. Additionally, the patient's mother, who had diabetes, worked with the patient, and created plans for diet, regular exercise, and weight management, and she helped create a food exchange list for glucose control. A scenario simulation of a daily diet after discharge stimulated the patient's thinking and enhanced the patient's motivation to improve their ability to manage their diabetes. When caring for adolescents with type 2 diabetes and managing their condition, we should construct self-management plans and integrate the hospital-household-school network for improved long-term care.

1. Hsu, H. C.,Chang, Y. H.,Lee, P. J.,Chen, S. Y.,Hsieh, C. H.,Lee, Y. J.,Wang, R. H.(2013).Developing and psychometric testing of a short-form problem areas in diabetes scale in Chinese patients.The Journal of Nursing Research,21(3),212-217.
   連結：
2. 徐慧君,李洮俊,王瑞霞(2019)。以病人為中心之第二型糖尿病血糖管理決策循環。護理雜誌，66(6)，5-12。
   連結：
3. Copeland, K. C.,Silverstein, J.,Moore, K. R.,Prazar, G. E.,Raymer, T.,Shiffman, R. N.,Springer, S. C.,Thaker, V. V.,Anderson, M.,Spann, S. J.,Flinn, S. K.(2013).Management of newly diagnosed type 2 diabetes mellitus (T2DM) in children and adolescents.Pediatrics,131(2),364-382.
4. Dart, A. B.,Martens, P. J.,Rigatto, C.,Brownell, M. D.,Dean, H. J.,Sellers, E. A.(2014).Earlier onset of complications in youth with type 2 diabetes.Diabetes Care,37(2),436-443.
5. Eva, J. J.,Kassab, Y. W.,Neoh, C. F.,Ming, L. C.,Wong, Y. Y.,Hameed, M. A.,Hong, Y. H.,Sarker, M. M. R.(2018).Self-care and self-management among adolescent T2DM patients: A review.Frontiers in Endocrinology,9(489),1-7.
6. Kliegman, R. M.(Ed.),Geme, J. W.(Ed.),Blum, N. J.(Ed.),Shah, S. S.(Ed.),Tasker, R. C.(Ed.),Wilson, K. M.(Ed.),Behrman, R. E.(Ed.)(2020).Nelson textbook of pediatrics.Elsevier.
7. Mayer-Davis, E. J.,Lawrence, J. M.,Dabelea, D.,Divers, J.,Isom, S.,Dolan, L.,Imperatore, G.,Linder, B.,Marcovina, S.,Pettitt, D. J.,Pihoker, C.,Saydah, S.,Wagenknecht, L.(2017).Incidence trends of type 1 and type 2 diabetes among youths, 2002-2012.The New England journal of Medicine,376(15),1419-1429.
8. Noordman, J.,Post, B.,van Dartel, A. A. M.,Slits, J. M. A.,Olde Hartman, T. C.(2019).Training residents in patient-centred communication and empathy: Evaluation from patients, observers and residents.BioMed Central Medical Education,19(128),1-11.
9. Sheen, Y. J.,Hsu, C. C.,Jiang, Y. D.,Huang, C. N.,Liu, J. S.,Sheu. W. H. H.(2019).Trends in prevalence and incidence of diabetes mellitus from 2005 to 2014 in Taiwan.Journal of the Formosan Medical Association,118(2),66-73.
10. 社團法人中華民國糖尿病衛教學會(2019).臺灣糖尿病年鑑 2019 第 2 型糖尿病.糖尿病衛教學會.
11. 社團法人中華民國糖尿病學會(2018).2018糖尿病臨床照護指引.糖尿病學會.
12. 張倩淇(2017)。兒童及青少年第 2 型糖尿病。家庭醫學與基層醫療，32(1)，2-8。
13. 曾嫦嫦(2012)。青少年及兒童糖尿病友及家庭的調適。中華民國糖尿病衛教學會會訊，8(2)，12-15。
14. 詹紹華,蔡明燕,邱智鈴,林為森(2018)。糖尿病共同照護於第二型糖尿病病人健康促進行為與糖化血色素控制之成效。澄清醫護管理雜誌，14(2)，50-57。
15. 衛生福利部統計處 (2020，6 月 16 日 )．衛生福利統計專區：108 年度死因統計結果分析．https://dep.mohw.gov.tw/DOS/cp-4927-54466-113.html
16. 鄭筱儒(2019)。青少年糖尿病病友在自我管理中的危機與調適。中華民國糖尿病衛教學會會訊，15(1)，22-24。
17. 蘇秀悅,成必筠,祝年豐(2014)。兒童及青少年過重及肥胖防治。醫學與健康期刊，3(2)，11-24。

1. (2023)。脆弱家庭兒童服務方案實施與成效分析──證據為基礎實務。社區發展季刊，184，408-425。