一位患有多發性骨髓瘤病人面對疾病復發之護理經驗

A Nursing Experience of a Patient with Multiple Myeloma Facing Recurrence

蘇敏鈴(Min-Ling Su)；蘇怡華(Yi-Hwa Su)；劉萍(Ping Liu)；梁麗麗(Li-Li Liang)

多發性骨髓瘤 ； 疼痛 ； 疾病復發 ； disease recurrence ； multiple myeloma ； pain

志為護理-慈濟護理雜誌

15卷1期（2016 / 02 / 01）

93 - 102

繁體中文

本文是照護一位患有多發性骨髓瘤病人面對疾病復發之護理經驗，個案在2010年1月開始經歷化學治療，並於2012年8月進行自體周邊血骨髓移植後，原本以為戰勝了病魔，但因反覆的下背痛而進出醫院後，經骨髓穿刺檢查確認疾病復發。照顧時間為2013年4月16日至4月23日，筆者運用身體評估、觀察、會談、團隊討論及病歷查閱，運用Gordon十一項功能性健康型態進行整體性評估與分析，發現個案有高危險性感染╱免疫力低下、高危險性傷害╱跌倒、疼痛、預期性哀傷╱與癌症復發等問題，除照顧生理之病痛，並透過陪伴、傾聽，運用團隊照護幫助個案共同面對疾病復發之心理問題，協助個案走出哀傷期，讓個案在面對未來的治療，不再徬徨無助，共同面對下一個可能的治療；護理人員若能適時提供護理指導、澄清疑慮並協助復發治療的選擇與決策，將能增強病人克服疾病壓力的勇氣。

This paper discussed a nursing experience of a patient with multiple myeloma as she faced the recurrence of the disease. After undergoing chemotherapy in Jan., 2010, and later receiving autologous peripheral blood stem cell transplantation in Aug. 2012, the patient thought the disease was cured, but a recently recurring lower back pain had brought him back to the hospital. It was confirmed by bone marrow biopsy that the disease had recurred. The nursing period was from April 16^(th) to 23^(rd), 2013. The author used physical assessment, observation, interview, team discussion and history taking to collect data, and conducted the Gordon's eleven-item functional health assessment to provide an overall evaluation and analysis of the patient. It was found that the patient had high risk of infection/low immunity, high risk of injury/fall, pain, anticipatory grief, and recurrence of cancer. In addition to nursing the patient’s physical pain, the author applied companionship, listening and team nursing to assist the patient in facing the psychological issues induced by the recurrence, and to face future treatment without the feeling of hopelessness. Nurses can strengthen patients’ courage to overcome the stress induced by diseases by providing timely nursing instructions, clarifying concerns, and assisting in the decision and planning in the treatment of recurring disease.

1. Chen, L. P.,Lin, S. J.,Yu, M. S.(2009).Plasma cell myeloma in southern Taiwan-Experience in a single institution.China Cancer Medical Society,25(5),326-335.
2. Lin, R. F.,Chang, J. J.,Lu, Y. M.,Huang, M. S.,Lue, Y. J.(2010).Correlations between quality of life and psychological factors in patients with chronic neck pain.The Kaohsiung Journal of Medical Sciences,26(1),13-20.
3. Mystakidou, K.,Tsilika, E.,Parpa, E.,Athanasouli, P.,Galanos, A.,Vlahos, L.(2009).Illnessrelated hopelessness in advanced cancer: Influence of anxiety, depression, and preparatory grief.Archive of Psychiatric Nursing,23(2),138-147.
4. Vivar, C. G.,Canga, N.,Canga, A. D.,Arantzamendi, M.(2009).The psychosocial impact of recurrence of cancer survivors and family members: A narrative review.Journal of Advanced Nursing,65(4),724-736.
5. 池惠民,張德高,邵榮華,黃玉苹(2013)。探討造血幹細胞移植之感染防護。長庚護理，24(2)，156-162。
6. 行政院衛生福利部(2013)．101年主要死因統計．取自http://www.mohw.gov.tw/cht/DOS/Statistic.
7. 呂依芳,呂佩佩(2010)。一位直腸癌末期患者之護理經驗。腫瘤護理雜誌，10(2)，109-119。
8. 沈孟璇,陳海焦(2011)。一位白血病人者移植後復發面對死亡焦慮之護理經驗。長庚護理，22(2)，267-275。
9. 周聖傑,黃聖懿(2012)。多發性骨髓瘤。台大醫網，76，9-12。
10. 明金蓮,洪曉佩(2011)。急性疼痛評估與症狀護理。源遠護理，5(1)，11-16。
11. 徐秉裕,王慧瑜(2013)。Bortezomib用於多發性骨髓瘤之治療。醫學雜誌，29(1)，76-80。
12. 劉家妤,莊情惠(2012)。一位復發性甲狀腺癌患者之護理經驗。新台北護理期刊，14(1)，117-126。
13. 蕭樑材(2013)。非血液科醫師如何避免延遲多發性骨髓瘤的診斷。台灣醫界，56(5)，262-267。
14. 顧艷秋(2010)。某醫學中心住院病人跌倒傷害及其相關因素探討。長庚護理，21(3)，287-298。

1. 龍紀萱、鄭芳如、梅慧敏、張淑真、林幸君(2017)。醫療團隊協助癌症末期個案生命意義之探索－以肺癌末期個案處遇為例。社會發展研究學刊，20，82-97。
2. 游馥蓮,陳瑋萍(2018)。陪伴一位婚前罹患急性骨髓性白血病個案之護理經驗。彰化護理，25(4)，40-52。
3. 鄭珮如,林美惠,李宜柔(2023)。照顧一位急性骨髓性白血病復發病人之護理經驗。長庚護理，34(3)，88-97。