一位初為人母經異體造血幹細胞移植之護理經驗

Nursing Experience of a Patient with Myelodysplastic Syndrome Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

林佳慧(Chia-Hui Lin)

《高雄護理雜誌》 35卷2期 (2018/08) Pp. 95-103

https://doi.org/10.6692/KJN.201808_35(2).0009

摘要

異體造血幹細胞移植視為治癒骨髓再生不良症候群的唯一方法。本文探討一位36歲初為人母罹患骨髓再生不良症候群，經異體造血幹細胞移植後因感染巨細胞病毒性結腸炎，致無法返家照顧幼兒，造成親子互動受限制及害怕無法負擔起母親的角色而出現情緒困擾之護理經驗，照顧期間自2015年6月11日至8月18日，筆者運用Gordon 11項功能性健康評估工具及會談、觀察、身體評估進行資料收集，確立有口腔黏膜破損、腹瀉、情緒困擾等健康問題，期間運用實證化照護指引有效減輕高劑量化學治療後口腔黏膜炎程度及腹瀉症狀，並一同擬訂親子照顧計畫重建親子關係，降低病人情緒困擾分數外，更增進對疾病的認知重拾治療信心，讓病人以正向態度因應疾病變化順利出院回歸家庭。

關鍵字

骨髓再生不良症候群 ； 母職 ； 造血幹細胞移植 ； 情緒困擾

並列摘要

Hematopoietic stem cell transplantation is generally considered the only way to cure myelodysplastic syndrome. This article describes the nursing care experience of a 36-year-old mother with myelodysplastic syndrome suffering from cytomegalovirus colitis who could not be successfully discharged to take care of her infant after allogeneic stem cell transplantation. During the treatment, the patient was afraid that she couldn’t be a responsible mother because of the disease. The nursing care period was from June 11 to August 18, 2015. We employed Gordon 11 function health patterns as a method of analysis and used observations and interviews to collect data. The patient had 3 health main problems: oral mucositis, diarrhea, and emotional distress. For preventing infection, we used unique features which effectively lowered the extent of diarrhea and oral mucositis after chemotherapy. We accompanied the patient to reduce her anxiety and increase her awareness of the disease. We also made a parent-child program, so that the patient could develop a positive attitude in response to self-empowerment and finally return home.

並列關鍵字

Myelodysplastic syndrome ； Motherhood ； Hematopoietic stem cell transplantation ； Emotional distress

參考文獻

周繡玲、謝嘉芬、李佳諭、江孟冠、紀雯真(2011)．癌症病人口腔黏膜炎臨床照護指引．腫瘤護理雜誌，11，61-85。

林青蓉、王碧華、楊翠雲、黃君瑜(2013)．癌症病患之子女的生活衝擊及適應．台灣醫學，17(2)，171-179。doi：10.6320/FJM.2013.17(2).10

林采蓉、黃敏瑢、粘惠先、劉佳琪、謝佩珊、陳淑惠(2015)．降低重症病房腹瀉病人失禁性皮膚炎發生率．護理雜誌，62(6)，81-89。doi：10.6224/JN.62.6.81

陳秋如、項怡平、王郁青、李炳鈺、王銘崇(2014)．使用Azacitidine治療骨髓化生不良症候群之高危險群病患之探討．臺灣臨床藥學雜誌，22(3)，175-182。doi：10.6168/FJCP.2014.2203.06

陳宜明、李明濱、林帛賢、廖士程(2013)．蓄意自傷行為之評估與處理．台灣醫學，17(3)，309-316。doi：10.6320/FJM.2013.17(3).12