一位急性骨髓性白血病個案接受化學治療之護理經驗

Nursing Care Experience of an Acute Myeloid Leukemia Patient Accepting Chemotherapy

本文是描述一位36歲男性罹患急性骨髓性白血病接受化學治療之護理經驗，護理期間自2010年5月24日至7月25日，運用觀察、會談、傾聽等技巧收集資料，並以紐曼系統之生理、心理、社會文化、發展及靈性等層面分析其壓力源，個案主要壓力源來自於因罹患急性骨髓性白血病接受化學治療，面臨治療過程中內在之生理、心理反應、適應行為，及其家屬在住院期間所面臨的壓力，而引起心理情緒低落。護理過程中主要確立四項護理問題，包含焦慮、潛在危險性感染、身體心像紊亂及家庭因應能力失調。針對個案住院期間主動提供家屬有關於疾病治療過程與預後情形，使其能克服心理障礙，進而順利調適因疾病引起的不適與焦慮；主動監測個案檢驗數據異常，提供避免續發性感染等二次傷害的護理措施；接受化學治療後落髮導致身體心像紊亂的問題，提供重建整體心像完整的措施，使其能接受本身外觀的改變，並增進其社交活動，介紹化療成效佳之病友彼此經驗分享；同時提供病人與家屬彼此更多的溝通機會，鼓勵及肯定家屬對病人的支持與協助，增進家庭成員互動及親子關係以排除對孩子之疏離感，並對後續治療抱持正向積極態度，順利完成此次化學治療。This case report describes a nursing care process of helping a 36 year old male patient accepting chemotherapy. From May 24 to July 25, 2010, the Neuman system model was applied for nursing assessment through observations, interviews, listening and communication. Chemotherapy and family coping behaviors were the main stress affecting patient's physical and mental conditions and reactions. Four health related problems were identified, including anxiety, risk for infection, body image disturbance and family coping ability. During the hospital staying period, the nurse provided information of disease and the prognosis to the patient and family, monitored the clinical data, introduced the successful case, and helped the family to communicate. Through nursing intervention, the patient and family decreased the anxiety and barriers to accept the therapy, improved family relationships and had a positive attitude toward the body image. Hopefully the nursing experience will be a reference for such cases in the future.