一位白血病復發合併中樞神經侵犯個案之護理經驗

本個案報告在探討一位49歲患有急性骨髓性白血病(Acute Myeloid Leukemia, AML）合併中樞神經侵犯的女性個案，在住院期間得知病情復發且中樞神經受侵犯後所面臨的身心反應與調適過程。護理個案期間自95年6月28日至95年7月17日為止，藉由觀察、身評、會談、實驗室檢驗數據及與醫療團隊人員、家屬訪談等資料，根據全人模式進行評估，發現個案因行化學治療導致骨髓抑制，白血球和血小板低下，中樞神經侵犯導致四肢無力，備感焦慮，故確立個案有無效性保護能力、潛在危險性損傷（出血）、身體活動功能障礙、焦慮等健康問題。護理過程中，採取保護性隔離措施，協助個案避免感染、出血，透過復健運動促進四肢活動力，在心理層面，對於其疾病復發及因無法自我照顧需依賴家人產生的情緒反應，以同理心的態度與個案和家屬建立良好關係，給予適時的心理支持，促使個案在身、心、社會方面有正向的調適，最後因病情穩定在家人與護理人員陪同下步行出院。筆者在照護過程中，運用全人概念於個案照護中，不僅能迅速發現個案的生理問題，更能深入探討心理及靈性層面，以確實執行全人整體性護理照顧。

關鍵字

急性白血病；中樞神經侵犯；癌症復發

並列摘要

The purpose of this paper was to describe a nursing experience with a patient suffering recurrent acute leukemia combined central nerves system involvement. The patient was female aged 49. The assessment tools were observation, health assessment, interview and medical history. The assessment was based on the concept of the whole-man and human responses. The four major health problems were as following: ineffective protection; risk for injury; impaired physical mobility; and anxiety. The patient was isolated in an isolation room to avoid getting infection. Afterward, she went to physical rehabilitation to train muscle power and regain self-care skills. The author provided psychological support with empathy to assist the patient and her family coping with the health problems and led the family having positive attitude toward disease adjustment.