一位化學治療後急性重症嗜中性白血球低下病人之加護經驗

Nursing Experience of Treating a Patient having Severe Acute Neutropenia with Chemotherapy in an Intensive Care Unit

林筱芳(Hsiao Fang Lin) ； 林文綾(Wen-Ling Lin)

《榮總護理》 34卷3期 (2017/09) Pp. 256-262

https://doi.org/10.6142/VGHN.34.3.256

摘要

化學治療是血癌病人免疫系統重建的機會，也是摧毀生命希望的重要治療。本文是一位血癌病人化學治療後因急性重症嗜中性白血球低下進住加護病房之加護經驗，護理期間自2015年05月29日至06月06日。藉由病歷查閱、身體評估與筆談、會談方式，以Gordon十一項功能性健康型態評估，確認個案的健康問題有氣體交換障礙、組織灌流改變/心肺、不確定感。依據敗血症早期復甦術治療指引，以肺保護模式確保氧合及預防肺部損傷、進行輸液復甦改善組織灌流，使個案順利渡過急性期並成功拔管。家屬對於個案病情驟變產生極大的不確定感，積極召開跨科整合家庭會議，使個案及案妻獲得足夠訊息，重拾治療希望，並提供加護病房同仁類似經驗之參考。

關鍵字

化學治療 ； 嗜中性白血球低下 ； 加護經驗

並列摘要

Although chemotherapy provides an opportunity for patients with leukemia to rebuild their immune systems, it can also have severe detrimental effects on their lives. This article describes the experience of treating a patient with acute myeloid leukemia in an intensive care. The patient's condition rapidly worsened because of induced neutropenia and septic shock after chemotherapy. From May 29 to June 06, 2015, data from medical records, physical assessments, and interviews were collected. The patient was evaluated using the framework of Gordon's 11 functional health patterns. The following major health issues were observed in the patient: gas exchange disorder, tissue perfusion changes in the heart and lungs, and anxiety caused by caretaker nervousness. According to the guidelines for early resuscitation in patients with sepsis, the lung protection mode should be adopted to ensure oxygenation and prevent lung injury, and fluid resuscitation is required to improve tissue perfusion. These measures enabled the patient to smoothly recover from the acute phase and be successfully extubated. During the process of deterioration due to the disease, the patient and his wife experienced great insecurity about the future. We contacted visiting staff from the Chest Medicine and Hematology Oncology Department to convene an interdisciplinary meeting. During this meeting, we offered clarification on the patient's questions, thereby enabling him to regain the faith in the treatment. We hope that this report can serve as a reference for the clinical nursing care of patients in similar situations.

並列關鍵字

chemotherapy ； severe acute neutropenia ； intensive care unit

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