急性骨髓性白血病人接受造血幹細胞移植之護理經驗

The Experience in Caring for an Acute Myeloid Leukemia Patient With Hematopoietic Stem Cell Transplantation

本文為描述一位初次罹患急性骨髓性白血病人接受造血幹細胞移植的護理經驗，造血幹細胞移植過程中，病人常因藥物副作用導致生理不適、感染、水腫等合併症，更因擔心疾病預後、移植復發等的不確定感，加重心理層面的壓力，故引發筆者想藉由文獻查證，將相關實證資訊運用於臨床，以協助個案渡過造血幹細胞移植療程。護理期間為2011年10月2日至11月20日，藉由身體評估、觀察、會談、連續性照護及與醫療團隊討論、病歷查閱等方式收集資料，運用Gordon十一項健康功能型態評估，發現個案有現存皮膚完整性受損、急性混亂、體溫過高等護理問題，運用個別性換藥、發燒處置、適時陪伴、傾聽、同理等護理措施，協助個案渡過急性混亂時期，透過個別性衛教指導，給予正確疾病照護知識、提供情緒支持，協助病人及家屬面對身、心、靈及社會等各方面的問題。由於移植後合併症所致，個案全身皮膚出現水泡進而破皮，造成皮膚照護的困擾，故建議增加專科病房的傷口照護相關課程，讓醫護同仁對於傷口照護有一致性、正確性的照護標準，期望此個案之照護經驗，能提供護理人員照護造血幹細胞移植病人之參考。

This article describes an experience in care of a patient diagnosed with acute myeloid leukemia and underwent hematopoietic stem cell transplantation. During the period of hospitalization, the patient suffered from possible complications of hematopoietic stem cell transplantation such as the side effects of drugs, infection, edema, and many more. In order to understand the patient's experience and to provide nursing care, this author aimed to apply evidence-based information and practice to help the patient endure the disease process and problems related to transplantation. Nursing care was provided when the patient was hospitalized for hematopoietic stem cell transplantation during October 2nd to November 20th, 2011. “Gordon's 11-item Functional Health Status” was applied to identify nursing problems. The patient had problems with skin integrity, acute confusion and hyperthermia. A series of thorough wound care and fever management were provided. Staying companionship and listening were implemented to reduce patient's uncertainty and instable emotions. Lastly, this author recommended that a wound care intensive training for staffs should be regularly arranged for a standard and consistent care for patients with leukemia and who will undergo hematopoietic stem cell transplantation.