護理師指導一位第一型糖尿病病人足部護理，應包含下列哪些內容？（選所有適合的）

核心概念：糖尿病足部護理的關鍵要素與預防策略。 為何正確答案對： A. 每日檢查足部：糖尿病患者因長期高血糖可能導致周邊神經病變（peripheral neuropathy）和血管病變（angiopathy），使足部感覺減退、血液循環不良，增加受傷和感染的風險。每日檢查足部，特別是留意是否有紅腫、水泡、割傷、潰瘍或感染跡象，是早期發現問題、及時介入的關鍵。 C. 徹底乾燥趾縫：趾縫部位容易潮濕，若有水分殘留，有利於黴菌（fungi）滋生，增加感染（如足癬，athlete's foot）的風險。因此，每次洗腳後，應輕柔地將趾縫徹底擦乾，維持乾燥是預防黴菌感染的重要措施。 D. 穿著合適的鞋襪：合腳的鞋子可以避免因摩擦、壓迫造成的傷害，例如水泡或潰瘍。而棉質襪子能吸收汗水，保持足部乾爽，並減少與鞋子之間的摩擦。選擇無縫線、合身的襪子，以及材質透氣、尺寸合適的鞋子，對預防糖尿病足部病變至關重要。 為何其他選項錯： B. 每日浸泡腳 30 分鐘：長時間浸泡在水中，尤其是在溫熱水中，會使皮膚角質層過度水合軟化（maceration），變得脆弱，更容易受損、破皮，增加感染風險。糖尿病患者的皮膚對溫度變化可能較不敏感，也增加了燙傷的風險。因此，不建議長時間浸泡。 E. 趾縫塗抹乳液：乳液的主要作用是滋潤乾燥的皮膚，防止龜裂。然而，趾縫部位本來就容易潮濕，若在此處塗抹乳液，會加劇潮濕環境，反而可能促進黴菌生長，增加感染風險。乳液應塗抹在足底、足背等較乾燥的區域，避開趾縫。 臨床思路：此題涉及糖尿病患者的自我照護能力與併發症預防。糖尿病足部病變是常見且嚴重的併發症，可能導致截肢。護理目標是教育病人採取能預防傷害、感染與促進癒合的措施。優先順序是教育病人如何進行日常自我評估與維持足部清潔乾燥，以及選擇合適的鞋襪。

Core concept: key elements and prevention strategies for diabetic foot care. Why the correct answers are right: A. Inspect the feet daily: long-standing hyperglycemia in diabetic clients can cause peripheral neuropathy and angiopathy, reducing sensation and impairing circulation in the feet and increasing the risk of injury and infection. Daily inspection, with particular attention to redness, blisters, cuts, ulcers, or signs of infection, is the key to early detection and timely intervention. C. Dry between the toes thoroughly: the spaces between the toes easily remain moist, and residual water creates an environment that favors fungal growth, increasing the risk of infections such as athlete's foot. Therefore, after each washing, the spaces between the toes should be gently and thoroughly dried; keeping them dry is an important measure for preventing fungal infection. D. Wear appropriately fitting shoes and socks: well-fitting shoes avoid injuries caused by friction or pressure, such as blisters or ulcers. Cotton socks absorb perspiration, keep the feet dry, and reduce friction with the shoes. Choosing seamless, well-fitting socks and breathable, properly sized shoes is crucial for preventing diabetic foot disease. Why the other options are wrong: B. Soak the feet for 30 minutes daily: prolonged immersion, especially in warm water, causes over-hydration and maceration of the stratum corneum, weakening the skin so it becomes more easily damaged and prone to infection. Diabetic clients may also be less sensitive to temperature changes, increasing the risk of burns. Prolonged soaking is therefore not recommended. E. Apply lotion between the toes: the main purpose of lotion is to moisten dry skin and prevent cracking. However, the spaces between the toes are already prone to being moist, and applying lotion there worsens the moisture and may instead promote fungal growth and infection. Lotion should be applied to drier areas, such as the soles and the tops of the feet, while avoiding the spaces between the toes. Clinical reasoning: this question concerns self-care ability and complication prevention in diabetic clients. Diabetic foot disease is a common and serious complication that can lead to amputation. The nursing goal is to educate the client about measures that prevent injury and infection and promote healing. The priority is teaching the client how to perform daily self-assessment, keep the feet clean and dry, and select appropriate footwear and socks.