一位骨髓發育不良症候群青少女行異體周邊血液幹細胞移植前之護理經驗

本文主要探討一位初診斷骨髓發育不良症候群青少女，疾病併發症未穩定前即接受異體周邊血液幹細胞移植，因深受疾病之苦，對後續治療產生無望感之護理經驗。護理期間2017／11／03－2017／12／26，藉由照護活動、觀察、會談及身體評估方式進行生、心、社會及靈性評估，確立護理問題有「嗜中性白血球低下併發感染」、「口腔及肛門黏膜炎疼痛導致營養少於身體所需」、「無望感」。照護過程中，落實執行保護性隔離照護，以減少感染發生；並採用口腔護理、口含碎冰塊、溫水坐浴、聆聽音樂等舒適護理，減緩疼痛不適。依年齡發展需求，以喜好之動漫和音樂與其建立關係，尊重其想法與主控權，運用視訊、通訊軟體維繫與同儕之聯絡互動，同理病人及案父母面臨罹病的併發症及後續治療看不到希望的負面感受，予關懷及支持，引導個案參與自我照顧增加自我控制感，從症狀的逐漸緩解鼓舞個案激發內在希望。青少年血液腫瘤科病人有其獨特心理社會發展及需求，也常為臨床護理師之照護困境，建議除了提供疾病照護之外，應依據青少年的發展階段與需求，融入此階段自我認同之發展特性，提供適切且符合的個別性照護，希冀此照護經驗可做為臨床照護之參考。

關鍵字

骨髓發育不良症候群；嗜中性白血球低下；無望感；青少年

並列摘要

This article aims to explore the nursing experience of a teenage girl with myelodysplastic syndrome who suffered from hopelessness while receiving allogeneic peripheral blood stem cell transplantation. The period of nursing care was from November 3 to December 26 of 2017. Three major health problems of neutropenia-related infection, oral and anus mucositis induced malnutrition, and a sense of hopelessness were identified through observation and interviews in the physical, psychological, social and spiritual aspects of the overall health assessment. Protective isolation care was implemented to reduce the risk of infection. Oral care, ice cubes, warm sitz bath, soft music and comfort care were used to alleviate pain and discomfort. A good patient/nurse relationship was built through sharing the favorite animation and music based on this teenage patient's developmental needs. The medical team showed respect to the patient's thoughts and sense of self-control, and used video and communication software to maintain the connection with her peers; empathize with her negative feelings of hopelessness about facing the complications and serious illness; provided support to guide the patient to participate in self-care which can empower the sense of self-control; and inspired internal hopes from the gradual relief of symptoms. Adolescent hematology and oncology patients have their own unique psychosocial development and needs, and they are often the plight of clinical nurses. In addition to providing patient care, it is recommended that according to the development stage and needs of adolescents, healthcare professionals should incorporate the self-identified development characteristics at this stage and provide appropriate and individualized care. It is hoped that this experience can be used as a reference for future clinical care of similar patients.

並列關鍵字

myelodysplastic syndrome ； neutropenia ； hopelessness ； teenager

參考文獻

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一位骨髓發育不良症候群青少女行異體周邊血液幹細胞移植前之護理經驗

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