1例老年脑梗死后遗症合并糖尿病低血糖恐惧患者的护理
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摘要
脑梗死的病死率和致残率较高,且多数患者发病后遗留不同程度的后遗症。糖尿病是脑梗死的危险因素,低血糖是糖尿病胰岛素治疗患者最常见的不良事件。低血糖恐惧是指由低血糖经历引起的各种令人厌恶的症状、情感、认知及不良的生理和社会后果。本研究总结1例老年脑梗死后遗症合并糖尿病低血糖恐惧患者的护理经验。患者入院后评估压疮、跌倒和坠床风险,评估疼痛程度、营养状况等一系列问题,并制定相应的护理计划,包括头痛护理、头晕护理、血糖控制、出院健康指导等。
Cerebral infarction, with a high rate of mortality and disability, can cause neurologic impairment and other sequelae. Diabetes mellitus is one of the important factors of cerebral infarction, and the hypoglycemia is most common adverse events in patients with insulin therapy. Fear of hypoglycemia is experienced at different levels by many people with diabetes, leading to adverse consequence on emotional, cognitive, physiological and social functions of patients. This paper reviewed the nursing management of cerebral infarction sequelae complicated with fear of hypoglycemia in a senile diabetic patient. The risk assessments on pressure sore, hospital fall and falling from bed, degree of pain and nutritional status of patients was carried out after hospital admission. Comprehensive nursing interventions were carried out including headache care, dizziness care, blood glucose control and health education before discharge form hospital.
Cerebral infarction, with a high rate of mortality and disability, can cause neurologic impairment and other sequelae. Diabetes mellitus is one of the important factors of cerebral infarction, and the hypoglycemia is most common adverse events in patients with insulin therapy. Fear of hypoglycemia is experienced at different levels by many people with diabetes, leading to adverse consequence on emotional, cognitive, physiological and social functions of patients. This paper reviewed the nursing management of cerebral infarction sequelae complicated with fear of hypoglycemia in a senile diabetic patient. The risk assessments on pressure sore, hospital fall and falling from bed, degree of pain and nutritional status of patients was carried out after hospital admission. Comprehensive nursing interventions were carried out including headache care, dizziness care, blood glucose control and health education before discharge form hospital.
引文
[1] HAN K T,PARK E C,SUN J K,et al.Effective strategy for improving health care outcomes:Multidisciplinary care in cerebral infarction patients[J].Health Policy,2015,119(8):1039-1045.
[2] 中国中西医结合学会神经科专业委员会.中国脑梗死中西医结合诊治指南(2017)[J].中国中西医结合杂志,2018,38(2):136-144.
[3] 王陇德,刘建民,杨弋,等.《中国脑卒中防治报告2017》概要[J].中国脑血管病杂志,2018,15(11):56-62.
[4] 梁瑜祯,伍秋霞,张普洪,等.门诊及住院2型糖尿病患者基础胰岛素起始治疗疗效及安全性比较的研究[J].中国糖尿病杂志,2018,26(9):20-24.
[5] ISMAIL-BEIGI F.Pathogenesis and glycemic management of type 2 diabetes mellitus:a physiological approach[J].Arch Iran Med,2012,15(4):239-246.
[6] CHAMBERLAIN J J,RHINEHART A S,JR S C,et al.Diagnosis and Management of Diabetes:Synopsis of the 2016 American Diabetes Association Standards of Medical Care in Diabetes[J].Ann Intern Med,2017,166(8):542-552.
[7] GARBER A J,ABRAHAMSON M J,BARZILAY J I,et al.Consensus statement by the American college of endocrinology on the comprehensive type2 diabetes management executive summary[J].Endocr Pract,2016,22(1):84-113.
[8] 中华医学会糖尿病学分会.中国2型糖尿病防治指南[M].北京:北京大学医学出版社,2014.
[9] INZUCCHI S E,BERGENSTAL R M,BUSE J B,et al.Management of hyperglycemia in type 2 diabetes,2015:a patient-centered approach:update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes[J].Diabetes Care,2015,38(1):140-149.
[10] 刘雅倩,雷梦杰,李玉峰,等.低血糖恐惧量表-15在2型糖尿病患者中的信效度检验[J].护理学杂志,2018,33(17):28-32.
[11] BATTELINO T,PHILLIP M,BRATINA N,et al.Effect of Continuous Glucose Monitoring on Hypoglycemia in Type 1 Diabetes[J].Diabetes Care,2011,34(4):795-800.
[12] HINNEN D,STRONG J.iGlarLixi:A New Once-Daily Fixed-Ratio Combination of Basal Insulin Glargine and Lixisenatide for the Management of Type 2 Diabetes[J].Diabetes Spectr,2018,31(2):145-154.
[2] 中国中西医结合学会神经科专业委员会.中国脑梗死中西医结合诊治指南(2017)[J].中国中西医结合杂志,2018,38(2):136-144.
[3] 王陇德,刘建民,杨弋,等.《中国脑卒中防治报告2017》概要[J].中国脑血管病杂志,2018,15(11):56-62.
[4] 梁瑜祯,伍秋霞,张普洪,等.门诊及住院2型糖尿病患者基础胰岛素起始治疗疗效及安全性比较的研究[J].中国糖尿病杂志,2018,26(9):20-24.
[5] ISMAIL-BEIGI F.Pathogenesis and glycemic management of type 2 diabetes mellitus:a physiological approach[J].Arch Iran Med,2012,15(4):239-246.
[6] CHAMBERLAIN J J,RHINEHART A S,JR S C,et al.Diagnosis and Management of Diabetes:Synopsis of the 2016 American Diabetes Association Standards of Medical Care in Diabetes[J].Ann Intern Med,2017,166(8):542-552.
[7] GARBER A J,ABRAHAMSON M J,BARZILAY J I,et al.Consensus statement by the American college of endocrinology on the comprehensive type2 diabetes management executive summary[J].Endocr Pract,2016,22(1):84-113.
[8] 中华医学会糖尿病学分会.中国2型糖尿病防治指南[M].北京:北京大学医学出版社,2014.
[9] INZUCCHI S E,BERGENSTAL R M,BUSE J B,et al.Management of hyperglycemia in type 2 diabetes,2015:a patient-centered approach:update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes[J].Diabetes Care,2015,38(1):140-149.
[10] 刘雅倩,雷梦杰,李玉峰,等.低血糖恐惧量表-15在2型糖尿病患者中的信效度检验[J].护理学杂志,2018,33(17):28-32.
[11] BATTELINO T,PHILLIP M,BRATINA N,et al.Effect of Continuous Glucose Monitoring on Hypoglycemia in Type 1 Diabetes[J].Diabetes Care,2011,34(4):795-800.
[12] HINNEN D,STRONG J.iGlarLixi:A New Once-Daily Fixed-Ratio Combination of Basal Insulin Glargine and Lixisenatide for the Management of Type 2 Diabetes[J].Diabetes Spectr,2018,31(2):145-154.