一位初診斷急性骨髓性白血病病人之照護經驗

The Nursing Experience of Caring for a Patient with Newly Diagnosed Acute Myelogenous Leukemia

陳姿螢(Zih-Ying Chen) ； 林德華(De-Hua Lin)

《馬偕護理雜誌》 15卷2期 (2021/07) Pp. 11-22

https://doi.org/10.29415/JMKN.202107_15(2).0002

摘要

本文敘述一位66歲初診斷急性骨髓性白血病病人，此次因癌症治療與過往經驗不同及無法掌控疾病變化，進而產生不確定感之照護經驗。照護期間2018年9月8日至10月24日，藉由身體評估、觀察、會談與查閱病歷等方式收集資料，進行生理、心理、社會及靈性之整體性評估，確立病人有潛在危險性感染、潛在危險性出血及不確定感的健康問題。於照護過程中，依循護理評估密切監測感染與出血徵象，早期發現感染或出血症狀，即刻介入醫療處置，同時與病人建立信任的護病關係，使其了解急性骨髓性白血病的病程發展與預後，鼓勵病人參與癌症治療計畫，此外藉由病友分享癌症心路歷程、尊重其宗教信仰等措施，增進其心靈安適以減緩不確定感。本單位缺乏合適的量表評估與評值病人不確定感之程度，因此建議未來可建構此評估工具，使護理人員能加以運用，以提升照護品質。透過此次分享期望能提供臨床照護之參考。

關鍵字

急性骨髓性白血病 ； 潛在危險性感染 ； 潛在危險性出血 ； 不確定感

並列摘要

This article described the nursing experience of caring for a 66-year-old patient with newly diagnosed acute myelogenous leukemia. She expressed a high level of uncertainty because the illness experience was different from her previous experiences including a lack of control on the progress of the cancer. The author conducted the comprehensive nursing assessment in physical, psychological, social and spiritual dimensions by using physical assessment, observation, interview, and review of medical records from September 8th to October 24th 2018. The health problems were identified as risk for infection, risk for bleeding, and feeling of uncertainty. The signs of infection and trust bleeding were monitored and treated them as early as possible. Meanwhile, a mutual nurse-patient relationship was established, and effort was made to provide guidance regarding the disease process of acute myelogenous leukemia, and encouraged her to participate in project for cancer therapy. In addition, we invited some patients to share their treatment experience of acute myelogenous Leukemia, and respected her religion and belief to promote her spiritual well-being and decrease the feeling of uncertainty. However, we did not have a suitable scale for assessing and evaluating the level of feeling of uncertainty, and therefore we suggested our unit to establish an appropriate assessment tool which can be used to measure the patient's level of feeling of uncertainty in future. We shared the nursing experience as a reference for nursing care of a patient with acute myelogenous leukemia.

並列關鍵字

acute myelogenous leukemia ； risk for infection ； risk for bleeding ； uncertainty

參考文獻

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