一位淋巴瘤少年行自體周邊血液幹細胞移植之護理經驗

Nursing Care for a Teenage Patient with Lymphoma Receiving Autologous Peripheral Blood Stem Cell Transplantation

10.3966/168395442016061601007

陳麗文(Li-Wen Chen)；林佩昭(Pei-Chao Lin)

化學治療 ； 淋巴瘤 ； 噁心 ； 周邊血液造血幹細胞移植 ； chemotherapy ； lymphoma ； nausea ； peripheral blood stem cell transplantation

腫瘤護理雜誌

16卷1期（2016 / 06 / 01）

61 - 72

繁體中文

周邊血液造血幹細胞移植治療已採用多年，護理人員在確保進行造血幹細胞移植的安全與照護品質扮演重要角色。本文描述一位罹患何杰金氏淋巴瘤與非何杰金氏淋巴瘤少年面對自體周邊血液造血幹細胞移植過程的護理經驗。護理期間為2013年2月18日至3月10日，筆者透過觀察、會談、身體評估等方式收集資料，確立個案主要護理問題為營養少於身體所需、舒適障礙：腹脹、潛在危險性損傷與社交隔離。依醫囑給予藥物治療外，採用穴位按摩、口腔清潔、轉移注意力等措施緩解個案噁心與腹脹不適。此外，落實保護性隔離之相關護理措施與指導個案移植期間的生活注意事項，使個案在移植過程中無發燒、感染等問題產生。利用主動關心、陪伴與鼓勵個案抒發感受等措施，改善個案因長期保護性隔離導致的社會隔離之孤寂感，使個案能主動計畫出院之後維持與家人及朋友之社交互動。建議腫瘤專科護理人員能於照護周邊血液造血幹細胞移植病人過程中，運用舒適理論為護理評估基礎，提供適合個案年齡發展與舒適需求的護理措施。

Peripheral blood stem cell transplantation therapy has been around for many years. Nurses play an important role in ensuring the safety and quality of care of stem cell transplantation. This paper describes a nursing care experience of a teenager with Hodgkin and non-Hodgkin lymphoma during the autologous peripheral blood stem cell transplantation from February 18 to March 10 in 2013. The data were collected through observation, interviews and physical examinations to identify the patient's problems including malnutrition, impaired comfort- abdominal distention, latent risk for injury, and social isolation. Aside from the medications administered according to the doctor's orders, pressure point massage, oral hygiene and attention diversion technique were used to relieve patient of nausea and abdominal distention. In addition, the implementation of protective isolation and patient education kept the patient free of fever and infection during the care period. In dealing with the inevitable sense of loneliness caused by the long term protective isolation, the author proactively offered empathy, companionship and encouragement that enabled the patient to express his feelings and initiate plans to reconnect with family and friends after discharge. We recommend oncology nurses to apply comfort theory and age suitable interventions based on the development stage and comfort needs of the patients during the nursing process of peripheral blood stem cell transplantation.

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