一位急性淋巴白血病之青少年行周邊血液幹細胞移植後之護理經驗

Nursing Experience of a Teenager with Acute Lymphoblastic Leukemia After Receiving Allogeneic Hematopoietic Cell Transplantation

10.6740/NTUHJN.202401_20(1).0007

吳采芬(Cai-Fen Wu)；曾紀瑩(Chi-Ying Tseng)；胡麗敏(Li-Min Hu)

急性淋巴性白血病 ； 急性疼痛 ； 異體周邊血液幹細胞移植 ； 高危險性感染 ； 青少年 ； Acute lymphoblastic leukemia ； acute pain ； hematopoietic stem cell transplantation ； higher risk for infection ； teenager

臺大護理雜誌

20卷1期（2024 / 01 / 01）

64 - 76

繁體中文;英文

本文描述一位16歲青春期少年診斷急性淋巴性白血病，接受周邊血液幹細胞移植之照護經驗。2021年8月2日至2021年8月22日護理期間，個案出現移植副作用及合併症，且擔心移植後返回學校之適應問題，運用生理、心理、社會及靈性等四大層面為評估工具，經觀察、身體評估、會談及查閱病歷來收集主客觀資料，依個案不適感受程度排序，確立個案有急性疼痛、高危險性感染、個人因應能力失調等健康問題。照護期間針對高劑量化學治療及全身放射線治療後的副作用，配合文獻查證提供專業及整合性護理措施，除給予止痛藥物外，給予口腔照護、尿管護理、變換姿勢等，緩解個案口腔及尿路疼痛程度，並增加自我照顧技巧以減少返家後感染風險，另考量個案發展階段特性，需更尊重其隱私範圍，予以正向回饋肯定個案，並鼓勵與同儕互動以重建自信。建議未來護理人員可多參與相關學協會課程及取得網路、影音、互動式APP等多元化的護理指導素材，提供病人更完善的照護，期望藉此護理經驗，可提供臨床護理人員在照顧青春期幹細胞移植病人時之參考。

This article describes the nursing care experiences of a 16-year-old adolescent with acute lymphoblastic leukemia who underwent stem cell transplantation. Data were collected from August 2 to 22, 2021, through observation, physical examination, interviews, and medical chart review. After assessing the four dimensions of physiological, psychological, social, and spiritual, health problems such as acute pain, high risk of infection, and coping disorders were identified. To help relieve the side effects after high-dose chemotherapy and whole-body radiation therapy, we provided nursing care that included evidence-based information for pain management, oral care, urinary catheter care, changing positions, and guiding and facilitating the patient's self-care skills to reduce the risk of infection after discharge. Considering the characteristics of the client's developmental stage, we encouraged him to maintain contact with his peers at school to rebuild his self-confidence. We suggest that nurses participate in association courses to acquire diverse nursing guidance materials, including online resources, videos, and interactive apps. This would enhance the provision of comprehensive care for patients, and all nursing interventions would be helpful in improving patients' well-being. Therefore, we share this nursing experience with the clinical nursing staff as a reference when caring for adolescents undergoing stem cell transplantation.