ALL個案化學治療後面臨潛在危險性傷害產生焦慮感之護理經驗

正值事業巔峰的年輕急性淋巴性白血病個案，面對疾病及化學治療造成骨髓抑制，併發全血低球下症狀，面臨潛在危險性傷害風險及腹瀉症狀困擾，因此產生焦慮感，有待協助進行適當的健康調適。護理期間為2018年7月29日至2018年9月2日，針對個案生理、心理、社會及靈性層面進行整體性評估，利用觀察、會談及病歷查閱方式收集資料，確立「焦慮」、「營養少於身體需要」及「潛在危險性傷害」等主要護理問題。透過技巧性的關懷同理，順利建立信任的護病關係，引導善用日記、冥想等技巧提升正向思考，強化調適能力；同時建立良好的團隊合作模式，透過適當代言釐清治療計畫相關疑問，照會營養師協助預防惡病質，臨床心理師協助調適病情告知後之衝擊，感染科醫師及臨床藥師加強監測藥物副作用及臨床應用成效，護理師善用藥物及非藥物之護理措施，緩解症狀困擾，並密切監測評估及穩定生命徵象，即時處理異常併發症，可維護個案安全，建立全人照護。建議應透過繼續教育，提升護理師身心靈社會問題評估、輔導技巧及敏銳度，善用跨團隊資源於複雜的血液腫瘤治療過程，於病人及團隊之間發揮適當溝通協調角色，以提升整體治療成效。

關鍵字

化學治療；嗜中性白血球低下；急性淋巴性白血病；潛在危險性傷害；焦慮

並列摘要

While in the prime of his career, a young patient with acute lymphoblastic leukemia, bone marrow suppression, and symptom of pancytopenia after chemotherapy faced potential risk of injury and the distress of diarrhea, causing him to nurse a sense of anxiety and in turn he needs to be properly assisted in expectation adjustment. During his hospitalization, from July 29th to September 2nd, 2018, holistic evaluations were done based on the patient's physiological, mental, social and spiritual needs. Through data collected from observations, conversations, and medical records, we ascertained the patient's primary nursing issues as ＂anxiety,＂＂nutrition decline (malnutrition)＂ and ＂potential risk of injury.＂ Out of empathy, we smoothly established the mutually trust-based relationship between the nurses and patient; furthermore, we instructed the patient to make the most of the benefits of journal-keeping and meditation to boost his positive thoughts and the ability to adapt. Additionally, we set up a good and close pattern of teamwork where the nurses appropriately elucidated the patient's relevant questions about therapeutic treatment; informed the nutritionists to assist the patient to prevent cachexia; clinical psychologists evaluated the impact of the disease on the patient and directed him on how to adjust his life; infectious disease physicians and clinical pharmacists reinforced their monitoring of the side effect of medicines and the clinical application effectiveness; the nurses accurately employed the nursing measure of drugs and non-pharmaceuticals to alleviate the patient's symptoms of the illness, closely monitored, assessed and stabilized the patient's vital signs as well as promptly dealt with the abnormal complications, all for the sakes of the patient's safety and holistic care. We suggest that professional nurses receive continuing education to enhance their capability in appraising patients' physical, mental and social needs with assistance techniques and acuity. At the same time, the nurses should tap into the resources from the cross-team collaboration for the complicated process of hematology treatment, serving as the competent liaison between patients and the team, which will heighten the effect of the overall therapy to deliver better outcomes.

並列關鍵字

chemotherapy ； neutropenia ； acute lymphoblastic leukemia ； potential risk of injury ； anxiety

參考文獻

王瑀容、游靖媚、鄭婉君、吳秀春（2018）．提升某腫瘤科病房醫療團隊病情告知完整性．馬偕護理雜誌，12（1），24-36。https://doi.org/10.29415/jmkn.201801_12(1).0002

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