照顧一位急性淋巴性白血病新生兒接受換血治療之護理經驗

Nursing Experience of Caring for a Newborn with Acute Lymphoblastic Leukemia Receiving Exchange Blood Transfusion

本文旨在探討一位診斷急性淋巴性白血病新生兒接受換血治療之護理經驗。筆者於2010年12月21日至12月26日照護期間，利用系統性身體評估、家庭會談及傾聽等方式收集資料分析歸納後，確立健康問題有：一、無效性保護能力與白血球過多、血小板低下及侵入性治療易受感染有關；二、混亂性嬰兒行為與侵入性治療如換血治療、抽血等導致疼痛及環境刺激有關；三、照顧者角色緊張與案父母擔心換血治療的副作用及無法預期病情預後有關。四、潛在危險性父母-嬰兒依附關係障礙/與個案住加護單位親子分離有關。提供主要護理措施，包括協助個案增加抵抗力、矯正血球不平衡、採集中護理、加強安撫縮短哭泣時間、降低週遭環境音量，以減少耗氧，並主動告知父母照護相關訊息、適時傾聽陪伴、提供彈性會客、給予正向鼓勵及錄製鼓勵性話語等以降低照顧者角色緊張。護理期間個案生命徵象穩定、熱量攝取足夠、睡眠規律未出現其他合併症，且協助下父母能主動參與日常生活照護，並建立良好親子依附關係，期望此經驗提供護理人員照顧之參考以提升護理專業照護品質。

This article described the nursing experience of caring a newborn with acute lymphoblastic leukemia receiving exchange blood transfusion. During the period from 2010/12/21 to 2010/12/26, through analyzing data collected from physical examinations, family conference, and parents’ statements, the health problems were identified as follows: 1. Ineffective protection that is related to leukocytosis, low platelet, and invasive procedures; 2. Disorganized infant behavior that is related to invasive procedures and environmental stimulation; 3. Caregiver role strain that is related to the fear for complications and prognosis; and 4. Risk for impaired attachment that is related to dissociation in the intensive care unit. Nursing care provided were to help increase resistance, to correct abnormal blood contents, to shorten the time of crying, to reduce the environmental noise, to decrease oxygen consumption, to provide the relevant information, to listen and accompany in time, to provide flexible meeting, and to decrease the anxiety level by supportive communication. During the caring period, the patient’s vital signs were stable, caloric intake was adequate, and sleep patterns were regular with no other complications. Parents could also actively participate in daily care, and establish a good parents-infant relationship. This report would serve as a reference for nursing staff for caring similar patients and improving quality of nursing care.