一位初診斷為第一型糖尿病學前兒之護理經驗

A Nursing Experience for an Elementary Preschool Child with Type I Diabetes Mellitus

10.29494/LN.201906_20(2).0005

黃彩雲(Cai-Yun Huang)；林宥葶(Yu-Ting Lin)

第一型糖尿病 ； 學齡前期 ； 初診斷 ； type 1 diabetes ； preschool child ； newly diagnosed

領導護理

20卷2期（2019 / 06 / 01）

55 - 71

繁體中文

本文在呈現照護一位初診斷第一型糖尿病學齡前期兒童之護理經驗，個案因體重下降，有多吃、多尿及容易口渴情形，至門診求治診斷為第一型糖尿病，對於頻繁測試血糖及施打胰島素產生恐懼，其父母也無法接受個案罹病的事實，故引發筆者探討如何協助個案與父母接受疾病。筆者於2015年10月29日至2015年11月5日照護期間，以羅氏適應模式為評估基礎，經由觀察、會談、身體評估及直接照護等方式收集資料，確定主要健康問題為：一、恐懼／與害怕測量血糖和施打胰島素有關；二、知識缺失／與案父母對糖尿病照護知識不足有關；三、照顧者角色緊張／對於執行照顧任務感到困難有關。筆者透過傾聽、關懷與支持的態度，鼓勵個案和主要照顧者表逹情緒，和個案一起閱讀「coco和高飛歡樂的一天」、「糖小虎與好朋友」等故事書，並運用角色扮演讓個案當玩偶的代言人，說出自己對治療的感受，進而降低打針的恐懼。配合衛教師、營養師團隊照護，幫助個案及主要照顧者學會第一型糖尿病照護知識與相關技巧。期望此護理經驗能作為未來臨床照護之參考。

This case report presents a nursing experience of a preschool child newly diagnosed with type 1 diabetes, who was admitted to the hospital due to weight loss, notion of hunger and thirst, as well as frequent urination. Observing the frequent tests and injections frightening the child and the situation was intolerable to patient's parents; the author was prompted on assisting the case and helping patient's parents to accept the condition. During the nursing care period, from October 29 to November 5, 2015, Roy's Adaption Model was applied to the assessment and the data were collected by means of observation, interviews, physical examination and direct care. The main health care problems were identified as follows: 1) Fear related to blood glucose test and insulin injections; 2) Insufficient knowledge in regards to diabetes caring; 3) Caregiver strain and burden occurs when caring mission becomes difficult. The author was listening, caring and supportive to the child and the primary caregiver was encouraged to express and share emotions. Furthermore, the child was accompanied with reading story books such as Coco and Goofy's Goofy Day and Sugar Tiger with Friend. In role-playing, the child was also made to share her feeling about the treatment and progressed to fear less of injections. In the end, the child and the primary caregiver were educated with knowledge and caring abilities in regards to Type 1 Diabetes by the educators and dietitians. This case report provides a valuable nursing care experience as a reference for similar diabetes cases in the future.

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