一位初次診斷急性骨髓性白血病病患之護理經驗

Nursing Experience of a Patient with Newly Diagnosed Acute Myeloid Leukemia

本文在探討一位21歲，初次診斷急性骨髓性白血病的病患，面臨癌症診斷與治療過程中身心反應、調適行為及其家屬在住院期間所面臨的壓力之護理經驗。護理個案期間自93年6月19日到93年8月1日，筆者依Gordon十一項功能性健康型態評估為評估指引，並運用深度訪談、紀錄、回溯及整理，確立病患有口腔黏膜改變、潛在危險性感染、身體心像紊亂、焦慮及家庭因應能力失調等健康問題。在護理過程中，筆者以同理心、尊重態度與病患及家屬建立信任及良好的治療關係。口腔衛生教導刷牙、使用牙線及口腔漱洗進而促進口腔黏膜的癒合；指導病患在人多地方應戴上口罩等預防感染護理措施，讓病患沒有感染發生。提供資訊及介紹成功的個案，引領病患分享心理感受、抒發負向情緒感受及改變，增強對自我身體正向的肯定與認識，承認並接受自己的改變，使病患逐漸的重建自我、面對未來的生活；並在病患的治療過程中主動提供家屬有關於疾病治療過程與預後情形，進而順利調適因疾病而引起的不適及焦慮，以增進家庭控制感和自尊。

This report described the nursing experience of a 21 years old patient who first time being informed the diagnosis of acute myeloid leukemia. This paper reported how the patient reacted mentally and physically to the diagnosis and treatment, how he adjusted himself, and the pressures suffered by his family during his hospitalization. The caring period was from June 19 2004 to August 1 2004. Five major nursing problems were identified using Gordon’s functional health assessment guide. They were altered oral mucous membrane, potential risk for infection, disturbed body image, anxiety, and ineffective family coping problems. Nursing intervention programs included using dental floss and mouth wash gargling to maintain oral hygiene and improve the healing of oral mucous membrane, putting on mask in the crowd to avoid infection, encouraging a positive attitude toward and understanding of his own body to reconstruct his new ego and face the future, providing his family with the information about his treatment and prognosis to reduce their anxiety, and establishing mutual trust relationship with his family through empathy and respect. This experience provided nursing staff with a reference to care for similar patients in the future.