頁籤選單縮合
題名 | 跨專業團隊照顧一位機構內糖尿病長者經驗=The Multidisciplinary Team Work in Caring a Resident with Diabetes in Long-term Care Facility |
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作者 | 黃畹藀; 葉淑芬; 王招靜; 陳昭元; | 書刊名 | 長期照護雜誌 |
卷期 | 15:3 2011.12[民100.12] |
頁次 | 頁273-283 |
分類號 | 419.76 |
關鍵詞 | 長期照護機構; 社區藥師; 藥物治療問題; 低血糖; 藥物治療評估; Long term care facility; Community pharmacist; Drug therapy problems; Hypoglycemia; Drug regimen review; |
語文 | 中文(Chinese) |
中文摘要 | 本文是描述一位長照機構的第二型糖尿病人,因同時罹患多種疾病,多位醫師看診,造成重覆用藥。而長者除了高齡外,還同時合併有心臟、肝臟及腎臟功能不全,持續服用抗糖尿病藥造成低血糖。長效的磺醯脲類抗糖尿病用藥gliclazide,在肝臟及腎臟功能不全時,會造成藥物的代謝及排除減少,並降低肝臟糖質新生作用,增加低血糖的危險。此外,病人服用的心臟病用藥carvedilol及amiodarone會控制心跳速率,造成病人低血糖時,並未出現手抖及心跳增加的症狀,增加偵測低血糖的困難度。同時,可能病人糖尿病罹病較久,造成低血糖不自覺,當低血糖發生時,除了冒汗外,也無饑餓感等抱怨。幸好社區藥師到機構執行藥物治療評估發現此狀況,在與機構護理人員討論及處理後,避免了嚴重低血糖事件的發生。最重要的是,當不同醫師對所開立的抗糖尿病藥各持己見時,家屬能支持護理師、藥師及營養師等,利用跨專業團隊的協助,使大部分藥物治療問題可獲解決。 |
英文摘要 | This article describes a resident in one long-term care facility, with type 2 diabetes and many other diseases, cared by different physicians so that polypharmacy exist and even received duplicated medications with similar pharmacological action. This older lady has heart, liver and kidney dysfunction taking a long-acting sulfonylurea, gliclazide (oral antihyperglycemia agents, OAA) for a long period of time and suffered hypoglycemia. Patient with hepatic and renal impairment will decrease the drug metabolism and clearance and reduce the hepatic gluconeogenesis result in high incidence of hypoglycemia. In addition, this patient takes carvedilol and amiodarone for her heart disease that causes loss of the typical hypoglycemic responses, such as tremor and tachycardia, making the detection of hypoglycemia even more difficult. Probably the patient suffering diabetes for a long period of time, she has no feeling of hypoglycemia symptoms; when hypoglycemia happened, except sweating, she has no hunger or other complaints. Fortunately, community pharmacist when providing drug regimen review found it out and resolved the problem with the nurse, to avoid the occurrence of severe hypoglycemia event. The most important thing is that at the situation when different physicians prescribe anti-diabetic medication with different opinion, family members could support the nurses, pharmacists and dietician, then with the multi-disciplinary team members collaborate together and most drug therapy problems can be quickly resolved. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。