一位急性淋巴性白血病病患接受化學治療之護理經驗

Nursing Experience Concerning an Acute Lymphoblastic Leukemia Patient Undergoing Chemotherapy

化學治療為急性淋巴性白血病的主要治療方式。本文提出一位被初次診斷罹患急性淋巴性白血病的病患，在面臨重大疾病及接受化學治療期間之護理經驗。筆者運用Gordon十一項功能性健康型態為評估指引，並經由觀察、會談、身體評估及病歷來收集資料，於2006年2月20日至2月28日護理期間，確立主要的健康問題有四項，包括：(1)潛在危險性感染；(2)保護能力改變；(3)口腔黏膜改變；(4)焦慮。護理重點為提供相關知識的衛教、減少感染及出血的合併症，經由口腔黏膜炎之分類等級評估後，依個案的個別性，改善口腔黏膜破損、以同理心鼓勵說出及傾聽內心感受與持續性的關懷，協助個案減輕焦慮、接受化學治療及身體外觀的改變，進而減少合併症、增進舒適及面對疾病治療歷程。在此提供護理經驗給臨床護理人員照顧此類患者之參考。

Chemotherapy is the main treatment for acute lymphoblastic leukemia (ALL). This study described the nursing experience of a patient who was diagnosed with ALL for the first time, facing serious illness, and undergoing chemotherapy. The researcher used Gordon’s 11 functional health patterns as assessment index, and collected data from observation, interview, physical assessment, and medical records. During the nursing period from February 20, 2006 to February 28, 2006, four main health problems were identified: 1) potential risk for infection: related to neutropenia and peripherally inserted venous catheter; 2) change in protection capability: related to thrombocytopenia; 3) altered oral mucous membranes; and 4) anxiety: insufficient knowledge about the illness and treatment process, and concern over the hair loss during chemotherapy. The focuses of nursing were on related health education, reduction of complications due to infection and hemorrhage, improving damage on oral mucous membranes based on the classification assessment of oral mucosa and personalities of the subject, encouraging the subject to expressing the feelings, providing continuous care, and assisting the subject to reduce anxiety and accept the chemotherapy, as well as the physical changes due to chemotherapy, in order to reduce complications, enhance comfort, and help the subject able to face the treatment process. The nursing experience provided clinical nurses with a reference for caring similar cases.