照顧一位急性淋巴性白血病確診COVID-19病人之加護經驗

Experience Caring for an Acute Lymphoblastic Leukemia Patient With COVID-19 in the ICU

本文為照護一位急性淋巴性白血病病人確診COVID-19之加護經驗。照護期間為2021年6月29日至7月12日，以直接照護、觀察、訪談及病歷查閱等方式收集資料，確認個案有感染、氣體交換障礙及無望感之健康問題。照護期間，提供支持性及組合式照護等感染控制措施，定期監測及追蹤感染相關指標，成功緩解現存感染及預防繼發性細菌感染；協助個案執行清醒俯臥治療，確認俯臥時呼吸器管路及導管之安全性及暢通性、依據血氧濃度及氣體分析調整呼吸器設定等呼吸照護措施，使個案氧合情形獲得改善並成功脫離呼吸器；延誤化療除影響急性淋巴性白血病存活率，更對病人身心造成巨大衝擊，利用以病人為中心溝通技巧，同理負向感受，鼓勵及協助參與自我照顧，協助照會血液腫瘤科醫師，提供清楚資訊，增進其自我控制感及正向態度，有效緩解個案對現況之無望感受。經由此照護經驗，建議利用社群軟體協助建立重要關係人群組，使隔離中的病人得到更好的家庭支持，建議於清醒COVID-19病人入院治療時，給予「COVID-19最新治療與照護資訊」相關的衛教手冊，透過清楚詳細的資訊，減輕此類病人的不確定感、增進自我照護認知，以順利度過漫長的隔離治療過程。

This article describes the author’s experience providing care in the ICU to a patient with acute lymphoblastic leukemia who had contracted COVID-19. The period of care spanned from June 29 to July 12, 2021. Data were collected during direct care, observations, and interviews and using medical record reviews. During the course of care, supportive care, bundle care, and other infection control measures were provided. The patient was monitored and tracked regularly for infection-related indicators, which successfully mitigated the impact of the infection and prevented secondary bacterial infections. Respiratory care measures such as assistance with Q3H awake prone positioning on the bed were provided. Also, the safety and smoothness of the ventilator pipeline and catheter when prone were confirmed and the setting of the ventilator was adjusted based on the blood oxygen concentration and gas analysis. These measures improved the patient's oxygenation, allowing their successful removal from the ventilator. Delayed chemotherapy affects the survival rate of patients with acute lymphoblastic leukemia as well as improves their physical and emotional status. Using patient-centered communication skills, empathizing with the patient’s negative feelings, encouraging and assisting their participation in self-care, and helping facilitate prescribed hematologist-oncologist care, the author helped increase the patient’s perceived self-control and positive attitudes and effectively alleviated their hopelessness regarding their current situation. Several recommendations arise from this care experience. Social media apps may be used to create virtual support groups for patients comprising significant relatives and friends to better support patients in quarantine. Also, a health education brochure addressing the latest COVID-19 disease, treatment, and care information may be given to patients with COVID-19 upon hospital admission to reduce their uncertainties and improve their self-care awareness to maximize their ability to successfully navigate the long quarantine treatment process.