照護一位接受骨髓移植前高劑量化療病人之護理經驗

Nursing Experience of Caring for a Patient Receiving High-dose Chemotherapy Before Bone Marrow Transplantation

10.6540/NTJN.202309_25(2).0010

周妤珊(Yu-Shan Chou)

骨髓移植 ； 高劑量化療 ； 自我照護 ； bone marrow transplant ； high-dose chemotherapy ； self-care

新臺北護理期刊

25卷2期（2023 / 09 / 01）

110 - 119

繁體中文;英文

本篇描述一位接受骨髓移植前高劑量化療病人之護理經驗，護理期間為2019年8月7日至2019年8月15日，以Gordon十一項健康型態評估，透過直接照護、身體評估、會談及觀察來收集資料，確認個案有營養失衡：少於身體需要、潛在危險性感染、焦慮之健康問題。護理過程中，透過化療期間口含冰塊的方法，緩解口腔黏膜炎造成的不適，配合日常的口腔護理，達到改善口腔黏膜炎的效果，並運用了食慾促進策略，讓個案自行設計菜單、調味，增加進食及提升營養攝取，在營養的提升及嚴格的感染預防與監控下，阻止感染的發生；筆者藉由與個案一同尋找資源、彙整資訊，整理出專屬於個案的衛教手冊，並反覆練習自我照顧技巧，例如口腔照護、洗手等，強化個案的自我照顧能力，並引導個案面對及解決問題，透過讓個案參與治療計劃，減輕對治療產生的不確定感，搭配個案的音樂喜好及給予按摩技巧的教導，達到放鬆及緩解焦慮情形。因本篇個案為青少年轉青壯年，處於學習如何作為一位為自己負責的大人的階段，建議未來照護上可多引導如何去面對及解決問題，並藉由與個案共同彙整疾病資料及反覆練習自我照顧技能，以提升自我照顧能力與建立信心。

This article describes the nursing experience of a patient who received high-dose chemotherapy before bone marrow transplantation. The nursing period was from August 7, 2019 to August 15, 2019. According to Gordon's eleven health assessments, the study was through direct care, physical assessment, interviews and observations to collect data to identify individuals with nutritional imbalances, including less than physical needs, potentially dangerous infections, and anxiety health problems. During the nursing process, the discomfort caused by oral mucositis could be relieved by the method of holding ice cubes in the mouth during chemotherapy, and the effect of improving oral mucositis could be achieved by cooperating with daily oral care. Appetite-promoting strategies were also used to allow patients to design their own menus and seasonings, increase food intake and increase nutritional intake, and prevent the occurrence of infection under the improvement of nutrition and strict infection prevention and monitoring. The author searched for resources and collected information together with the case, and organized the health education manual for the case. Practice self-care skills such as oral care and hand washing were used to strengthen the self-care ability of the client, and guide the client to face and solve the problem. Massage techniques were also taught to relax and relieve the client's anxiety. The case in this article is a young adult who is in the stage of learning how to be an adult who is responsible for himself to practice self-care skills in order to improve self-care skills and build confidence.

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