護理師指導新診斷第二型糖尿病的病人足部護理。下列病人敘述何者表示已理解護理指導？（選所有適合的）

核心概念：第二型糖尿病（Type 2 Diabetes Mellitus）患者的足部自我照護教育。 為何正確答案對： A. 「我每天會檢查我的腳，看看有沒有水泡、割傷或紅腫。」：這是糖尿病足部護理的核心要求。由於神經病變和血管病變，糖尿病患者的足部容易受傷且癒合不良。每日自我檢查是早期發現損傷、預防感染和潰瘍的關鍵步驟。 C. 「我會在下午腳有點腫的時候去買新鞋。」：腳部在一天中，尤其是在站立和活動後，會有輕微的生理性水腫。下午購買鞋子可以確保鞋子在腳部最寬、最腫脹的狀態下仍然合適，避免購買過小的鞋子，防止因鞋子不合腳而造成的摩擦、壓迫，進而預防水泡和潰瘍。 D. 「我會塗抹乳液在腳上，但避開腳趾之間的部位。」：糖尿病患者的皮膚容易乾燥，塗抹乳液（lotion）有助於保持皮膚濕潤，預防龜裂。然而，腳趾之間的縫隙容易潮濕，若塗抹乳液，會增加潮濕度，可能導致黴菌（fungi）滋生，引起足癬（athlete's foot）等感染。因此，應將乳液塗抹在足底、足背等部位，避開趾縫。 E. 「我會將腳趾甲修剪成直線，以防止嵌甲。」：腳趾甲（toenails）若修剪成圓弧形，邊緣容易刺入周圍的軟組織，導致甲溝炎（paronychia）或嵌甲（ingrown toenails）。將腳趾甲直剪（straight across）並稍微修圓邊緣，是預防嵌甲的正確方法。對於糖尿病患者，應由病人自己或在護理人員指導下進行，避免自行修剪不當造成傷害。 為何其他選項錯： B. 「我每晚睡前應該用熱水泡腳。」：長時間浸泡在熱水中（especially hot water）會使糖尿病患者的皮膚角質層過度水合軟化（maceration），變得脆弱，容易受傷、破皮。此外，糖尿病患者對溫度感覺可能較遲鈍，容易在不知不覺中燙傷。因此，不建議用熱水長時間泡腳。 臨床思路：此題考量糖尿病患者的自我照護技能，重點在於預防足部併發症。護理師應教育病人正確的足部清潔、檢查、保濕、穿鞋和修剪指甲的方法。病人能準確複述這些重要原則，才表示其已理解護理指導。

Core concept: foot self-care education for clients with type 2 diabetes mellitus. Why the correct answers are correct: A. "I will inspect my feet daily for blisters, cuts, or redness": This is a cornerstone of diabetic foot care. Because of neuropathy and vascular disease, the feet of clients with diabetes are vulnerable to injury and heal poorly. Daily self-inspection is essential for early detection of injury and prevention of infection and ulceration. C. "I will buy new shoes in the afternoon when my feet are slightly swollen": Feet undergo slight physiological swelling during the day, especially after standing and activity. Shopping in the afternoon ensures that shoes fit when feet are at their widest and most swollen, avoiding shoes that are too small and preventing friction, pressure, blisters, and ulcers. D. "I will apply lotion to my feet, but avoid the areas between the toes": The skin of clients with diabetes tends to be dry, and applying lotion helps keep skin moist and prevents cracking. However, the spaces between the toes tend to remain moist, and applying lotion there increases moisture and may foster fungal growth and infections such as athlete's foot. Lotion should be applied to the soles and tops of the feet but not between the toes. E. "I will trim my toenails straight across to prevent ingrown nails": Trimming the toenails in a curved shape allows the edges to press into the surrounding soft tissue, leading to paronychia or ingrown toenails. Cutting toenails straight across and lightly rounding the edges is the correct method to prevent ingrown nails. For clients with diabetes, this should be done by the client or under the guidance of a nurse to avoid inadvertent injury. Why the other option is incorrect: B. "I should soak my feet in hot water every night before bed": Prolonged immersion in hot water causes maceration of the skin's keratin layer, making the skin fragile and prone to injury. In addition, clients with diabetes may have impaired temperature sensation and can sustain burns without noticing. Soaking the feet in hot water is therefore not recommended. Clinical reasoning: This question addresses self-care skills for clients with diabetes, emphasizing the prevention of foot complications. The nurse should educate the client about proper foot cleansing, inspection, moisturizing, footwear, and nail trimming. Accurate restatement of these principles by the client indicates understanding of the teaching.