照護一位青少年期罹患急性骨髓性白血病病人之護理經驗

Nursing Experience of an Adolescent Patient with Acute Myeloid Leukemia

10.6880/TJON.202112/SP_21.02

翁于晴(Yu-Ching Weng)；謝佩琪(Pei-Chi Hsieh)；陳淑真(Shu-Chen Chen)；黃雅凰(Ya-Huang Huang)

急性骨髓性白血病 ； 青少年期 ； 護理經驗 ； acute myeloid leukemia ； adolescent ； nursing experience

腫瘤護理雜誌

21卷增訂刊II（2021 / 12 / 01）

19 - 32

繁體中文

本文描述照護一位青少年期罹患急性骨髓性白血病病人之護理經驗。照護期間為2018年7月4日至8月3日，病人為籃球校隊風雲人物，發現罹癌後無法從事熱愛的運動，且擔心化學治療副作用影響生育能力，對於治療過程及預後產生不確定感，故引發筆者收案動機。以病人為中心，依照生理、心理、社會、發展及靈性層面進行整體性評估，確立病人有保護能力改變、營養少於身體需求、焦慮等之健康問題。護理過程透過跨團隊專業合作，針對疾病提供正確自我保護之知識與技能，避免血球低下引發感染、出血；於化學治療期間指導內關穴穴位按摩緩解噁心感，依據喜好訂定飲食計畫以維持充足營養攝取；轉介生殖專科團隊進行精子保存，減緩焦慮感，藉由白血病支持團體分享癌友抗癌心路歷程，改善癌症治療認知，並進一步於出院前順利完成骨髓配對。藉此經驗分享給臨床醫護人員照護此類病人之參考，建議強化青少年期罹癌病人身心評估技巧，依需要盡早轉介專責心理師。

This paper describes the nursing experience of an adolescent patient with acute myeloid leukemia. The caring period was between July 4 and August 3, 2018. The patient was a very popular member on the school basketball team. After he was diagnosed with cancer, he could no longer play his favorite sport and was concerned that the side effect of chemotherapy would affect his reproductive function. He was uncertain about the treatment process and the prognosis, which prompted the author of this study to take this case. A patient-centered holistic evaluation was conducted on the physiological, psychological, social, developmental, and spiritual levels. It was revealed that the patient had health problems including perception change in self-protection, decreased nutrient intake, and anxiety. During the nursing period, cross-team professional collaboration was conducted. The patient was provided with correct self-protection knowledge and skills for disease management to avoid pancytopenia, which triggers infection and bleeding. During the chemotherapy treatment, the patient was taught to massage Neiguan acupoint to alleviate nausea. A dietary plan was made according to his preference to maintain sufficient nutrient intake. The patient was also referred to the reproductive specialists team for sperm preservation to alleviate his anxiety. In addition, he was introduced to the leukemia support groups to learn about other cancer patients' experiences to build his awareness about cancer treatments. Before he was released from the hospital, he was successfully matched with a healthy person for hematopoietic stem cell transplantation. We hereby share this experience with the clinical medical and nursing staff as a reference for caring for this type of patients. We recommend that the skills for evaluating adolescent cancer patient' physiological and psychological states should be strengthened. When needed, these patients should be referred to the psychologists.

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