照護一位青少年接受移植術後發生排斥合併感染之護理經驗

Nursing experience of caring a teenager who suffered from rejection combined with infection after transplantation

10.6386/CGN.202203_33(1).0008

施驊珊(Hua- Shan Shih)；林宥葶(Yu-Ting Lin)；陳雅雯(Ya-Wen Chen)；謝幸君(Hsing-Chun Hsieh)；溫玉娟(Yu-Chuan Wen)

移植 ； 青少年 ； 巨細胞 ； 排斥 ； transplantation ； teenagers ； CMV ； Rejection

長庚護理

33卷1期（2022 / 03 / 01）

85 - 92

繁體中文

本文描述一位罹患嚴重再生性不良性貧血青少年，接受造血幹細胞移植後產生皮膚排斥及感染巨細胞病毒而入院治療之護理經驗。個案因反覆入院與同儕疏離，使得負向情緒累積產生自殺意念，故引發筆者書寫動機。護理期間自2018年2月22日至2018年3月15日，以Gordon十一項健康功能型態評估，藉由會談、觀察、身體評估及病歷資料收集等方式，確立三個主要健康問題有：無效性保護能力、身體心像紊亂及無望感。依個案皮膚排斥症狀與血球低下給予皮膚照護及預防感染衛教，個案因皮膚脫屑起紅疹而面臨身體外觀改變、因長期住院，與同儕疏離導致負面情緒累積而出現自殺意念，運用同理心、傾聽、主動關懷及了解個案興趣，由個案喜愛的電玩去轉移負向情緒，並引導重新建立個人價值觀。造血幹細胞移植已被視為血液腫瘤疾病治療的重要選擇，臨床醫療團隊除了具備有移植相關照顧概念外，建議可安排團體衛教，加強記憶點，供家屬和病人學習，另外良好的同儕關係能幫助青少年度過治療歷程，因此護理人員應將同儕一同納入照護計畫中協助個案，同時安排相似年齡病友的探視以促進適應過程。

The report described the nursing experience of caring a teenager with aplastic anemia who was admitted due to skin rejection after receiving hematopoietic stem cells transplantation and CMV infection. The patient also had suicide attempt due to repeated hospitalization. The caring duration was from Feb. 22, 2018 to Mar. 15, 2018. The patient was evaluated by using Gordons 11-functional-health-patterns assessment. The data were collected via directly nursing care, observation, holistic interview, and physical examination. The major health problems included 1. ineffective protection, 2. disturbed body image, and 3. hopelessness. To alleviate symptoms of skin rejection and the condition of pancytopenia, health education about preventing infection and skin care was provided. Negative emotion and suicide attempt due to the change of appearance caused by desquamation skin rash and the alienation with classmates because of long-term hospitalization were improved by listening, empathy, active care, and understanding of the patient's interest. We distracted the negative emotion by patient's favorite - online game and instructed the patient to establish his personal value. Hematopoietic stem cells transplantation was one of the important treatments of hemato-oncological disorders. Hence, besides the concept of nursing care of hematopoietic stem cells transplantation, we recommend health information about the complications after transplantation can be provided to patients and their families. Animation combined with printed information help strengthen the memory power. In addition, good relationship between the patient and the peers could help the patient to overcome the difficult experience resulting from treatment. Nursing staff could encourage visits from patients' friends or family members during hospitalization. Visits from the same age wardmates also help promote the adaptative process.

1. 林育陞, Y. S.(2016)。青少年青春期生、心理健康之探究。諮商與輔導，364，5-8。
   連結：
2. 梁天麗, T. L.,廖怡珍, I. C.,李美麗, M. L.,林冠品, K. P.(2014)。造血幹細胞移植病患住院期間主觀治療經驗。弘光學報，74，82-101。
   連結：
3. 池惠民, H. M.,張德高, T. K.,邵榮華, J. H.,黃玉苹, Y. P.(2013)。探討造血幹細胞移植之感染防護。長庚護理，24(2)，156-162。
4. 陳彥伶, Y. L.,蕭伊汝, Y. J.,李彩緣, C. Y.(2017)。照護一位青少年創傷膝上截肢之護理經驗。安泰醫護雜誌，23(1)，29-41。
5. 黃盈芷, Y. C.,戴玉慈, Y. T.,李啟誠, C. C.(2014)。造血幹細胞移植後嚴重植體抗宿主疾病之護理經驗。台灣醫學，18(6)，634-640。
6. 蔡欣玲（編）(2014).當代人類發展學.華杏=Farseeing.
7. 蕭逸美, Y. M.,邱倫瑋, L. W.(2013)。造血幹細胞移植後急性移植物抗宿主疾病及其護理。腫瘤護理雜誌，13(2)，15-25。