照護一位骨髓增生異常移植後產生慢性移植物對抗宿主疾病病人之護理經驗

The Experience of Caring for a Myelodysplastic Syndrome Patient with Graft-Versus-Host Disease after Transplantation

宋筱可(Sung, Shiao-Ke) ； 李鴻春(Lee,Hung-Chun)

《臺大護理雜誌》 14卷2期 (2018/07) Pp. 134-146

https://doi.org/10.6740/NTUHJN.201807_14(2).0013

摘要

本文探討一位39歲骨髓增生異常轉變急性白血病，接受造血幹細胞移植個案（Hematopoietic Stem Cell Transplantation, HSCT），引發生理不適、外觀改變與心理壓力調適之照護經驗。護理期間自2016年9月24日至11月10日，運用Gordon 11項健康功能型態架構評估，透過直接照顧、觀察、身體評估與個案互動、會談收集資料，確立個案有低效性呼吸型態、活動無耐力、皮膚完整性受損、身體心像改變之健康問題。護理過程中主動與個案及家屬建立良好護病關係，運用同理心、傾聽陪伴、情緒支持，鼓勵說出內心想法與感受，以個案為中心，提供個別性的照護及相關性的護理指導，像是皮膚完整性照護、偕同物理治療師執行呼吸運動訓練以及教導呼吸技巧減少心肺做功等。建議未來能有針對移植術後造成排斥反應之護理臨床照護指引，減少病人住院天數，提升病人生活品質，期望藉此護理經驗，提供護理師日後照護類似病人之參考。

關鍵字

骨髓增生異常症候群 ； 造血幹細胞移植 ； 移植物對抗宿主疾病

並列摘要

This article describes the nursing experience of caring for a 39-year-old patient who had myelodysplastic syndrome that transformed into acute leukemia and accepted hematopoietic stem cell transplantation. After the transplantation, the patient suffered from physical discomfort, an appearance change, and psychological stress. The nursing period lasted from 24^(th) September to 10^(th) November 2016. We used the Gordon's 11-item health function-type structure assessment to collect information through direct care, observation, a physical assessment, case interaction, and an interview. The identified health problems included (1) ineffective breathing patterns, (2) activity intolerance, (3) impaired skin integrity, and (4) body image disturbance. During the nursing period, the patient and his family were interacted with proactively to establish a good nurse-patient relationship. Empathy, listening, accompaniment, and emotional support were used to encourage the patient to share his thoughts and feelings. Case-centered care, individual care, and nursing care instructions were given, such as skin integrity care, respiratory exercise training with a physiotherapist, and teaching breathing skills to reduce heart and lung work. It is suggested that a nursing guideline is needed for transplantation rejection. This would reduce the length of hospitalization and improve the patient's quality of life. It is expected that this nursing experience will be a reference for registered nurses caring for similar patients in the future.

並列關鍵字

myelodysplastic syndrome ； hematopoietic stem cell transplantation ； graft-versus-host disease