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

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。

關鍵字

急性骨髓性白血病；青少年期；護理經驗

並列摘要

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.

並列關鍵字

acute myeloid leukemia ； adolescent ； nursing experience

參考文獻

李耀泰、陳福民、郭宗正（2017）．化學治療引起的突發性噁心嘔吐的檢視．臨床醫學月刊，80（2），475-478。[Li, Y. T., Chen, F. M., & Guo, Z. J. (2017). Review of sudden nausea and vomiting caused by chemotherapy. Clinical Medicine, 80(2), 475-478.] https://doi.org/10.6666/ClinMed.2017.80.2.088

洪筱瑩、黃美智（2014）．同意與贊同-青少年接受骨髓移植之倫理考量．護理雜誌，61（4），83-89。[Hung, H. Y., & Huang, M. C. (2014). Consent vs. assent: Ethical considerations related to bone marrow transplantation in adolescents. The Journal of Nursing, 61(4), 83-89.] https://doi.org/10.6224/JN.61.4.83

高文揚（2017）．探討大學生身心健康狀況與生活滿意之關係研究．運動與遊憩研究，12（1），116-130。[Kao, W. Y. (2017). Exploring the relationship between life satisfaction and physical and mental health among college students. Journal of Sport and Recreation Research, 12(1), 116-130.] https://doi.org/10.29423/JSRR.201709_12(1).0010

陳美碧、莊紫雲、謝麗鳳（2015）．化療引致噁心嘔吐之發生率及其相關因素．護理暨健康照護研究，11（3），206-215。[Chen, M. B., Chuang, T. Y., & Hsieh, L. F. (2015). Incidence and related factors of chemotherapy-induced nausea and vomiting. Journal of Nursing and Healthcare Research, 11(3), 206-215.] https://doi.org/10.6225/JNHR.11.3.206

陳麗麗、林君黛（2015）．穴位按壓與實證護理．護理雜誌，62（6），27-34。[Chen, L. L., & Lin, J. D. (2015). Acupressure and evidence-based nursing. The Journal of Nursing, 62(6), 27-34.] https://doi.org/10.6224/JN.62.6.27

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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

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