照護一位急性骨髓性白血病病人接受異體造血幹細胞移植之護理經驗

Nursing Experience of Caring for a Patient with Acute Myeloid Leukemia Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

本文主要描述一位急性骨髓性白血病病人接受異體造血幹細胞移植之護理經驗，個案接受誘導性化學治療後疾病復發，而進行異體造血幹細胞移植。筆者於2020年11月5日至12月9日照護期間，運用Gordon十一項健康功能型態評估進行護理評估，發現個案有焦慮、無效性保護能力及口腔黏膜受損之健康問題。護理措施為協助並教導個案預防感染及出血之措施，口腔黏膜破損則運用適當的口腔清潔照護方式，使得個案口腔黏膜破損逐漸癒合。另外，當個案對於造血幹細胞移植治療過程及對疾病未來預後之不確定感，產生不安與焦慮，運用同理心並建立信任關係，提供持續性及一致性的照護措施與關懷，並運用放鬆技巧及聆聽音樂轉移注意力，鼓勵家屬讓個案抒發心情提供支持，改善個案因治療期間所發生之身體不適並減輕焦慮，期望藉此照護經驗之分享，有助提升照護品質。

This article presents a nurse’s clinical experience in providing care for a patient with acute myeloid leukemia (AML) following hematopoietic stem cell transplantation (HSCT). The patient experienced disease relapse after induction chemotherapy and subsequently underwent HSCT. Nursing care was provided during the patient’s hospitalization for HSCT from November 5 to December 9, 2021.
Gordon’s 11 Functional Health Patterns framework was applied to comprehensively assess the patient’s condition. The primary nursing problems identified were anxiety, ineffective protection, and impaired oral mucous membrane integrity. To prevent infection and bleeding, a series of nursing interventions were implemented, including fever management and oral care aimed at promoting the healing of oral ulcers.
The patient’s uncertainty regarding the HSCT treatment process and disease prognosis contributed to heightened anxiety and emotional distress. Through the provision of consistent, empathetic, and sustainable nursing care, a trusting nurse–patient relationship was established. The nurse also encouraged communication with family members and friends, as well as engagement in relaxation and meditation activities, to alleviate stress and stabilize emotions during hospitalization.
This case report is shared to provide a reference for clinical healthcare and nursing professionals, offering practical insights for the management and psychosocial support of patients undergoing hematopoietic stem cell transplantation.