照顧一位急性骨髓性白血病復發病人之護理經驗

A Nursing Experience of a Patient with Recurrent Acute Myeloid Leukemia

本文是照護一位急性骨髓性白血病病人面對疾病復發時，在身心方面所造成的衝擊之護理經驗。照顧期間為2019年5月2日至5月25日，筆者以觀察、會談、身體評估及病歷查閱，運用Gordon十一項健康型態進行評估，發現病人有無效性保護能力、腹瀉及焦慮等健康問題，於護理期間，透過身體評估、評估飲食內容，提供衛教指導，積極與醫療團隊討論病人狀況，預防其出現次發性感染，並提供無痛保護膜避免腹瀉造成皮膚刺激，適時的陪伴與關懷建立信任感，讓病人能說出內心的想法，透過家庭會議邀請家屬共同討論，病人認知疾病復發的事實與因應，並教導以呼吸放鬆法、肌肉放鬆法，來紓解放鬆焦慮的感覺。建議藉由家庭會議進行溝通，幫助病人面對疾病進展及治療，做出最適當的醫療決策，使身、心、靈感受到安定與舒適，達到癌症病人連續、完整的照護。

This article described the nursing experience of caring for a patient diagnosed with acute myeloid leukemia (AML) as the patient's physical and mental shock when facing the disease recurrence. The duration of nursing care was from May 2nd to May 25th, 2019. The author used observation, interview, physical assessment, and history taking to collect data, and conducted the Gordon’s eleven-item functional health assessment to evaluated of the patient. It was found that the patient had ineffective protection, diarrhea, and anxiety. During the nursing period, through physical assessment and diet assessment providing health education guidance, actively discussing the patient’s condition with the medical team to prevent secondary infections, also provide a painless protective film to avoid skin irritation caused by diarrhea, build a sense of trust with timely companionship and care, so that the patient can express their inner thoughts, and through family meetings invite family members to discuss together and guide patients to recognize the facts of disease recurrence and how to respond. The care team also Instructed breathing relaxation technique and muscle relaxation to relieve the feeling of anxiety. It is recommended to communicate through family meetings to help patients face disease progression and treatment, and make the most appropriate medical decisions, so that body, mind, and inspiration are stabilized and comfortable, to achieve continuous and complete care for cancer patients.