協助一位白血病復發病人經歷嚴重化學治療副作用之照護經驗

本文為描述一位白血病個案在接受異體造血幹細胞移植後半年內即再度復發，被迫取消原本返回職場之計畫，接受化學治療後經歷嚴重副作用，同時面臨疾病治療計畫的不確定，使其身心承受極大的壓力，引發撰寫動機。護理期間為2020/4/29至2020/5/28，藉由會談、觀察、身體評估、病歷查閱等方式收集資料，以身心靈及社會等層面做整體性評估，確立個案有現存性感染合併敗血性休克、口腔黏膜改變、不確定感、自我照顧功能下降、疼痛、腹瀉、皮膚完整性受損等健康問題。透過醫療團隊合作積極處理感染問題，穩定生命徵象，搭配藥物使用及教導口腔護理，降低口腔黏膜炎的不適，運用溝通技巧釐清個案不確定感的來源，協助與主治醫師進行溝通，教導正念減壓及放鬆技巧，協助個案順利從各種不適症狀中逐漸恢復。建議臨床單位定期舉辦敗血症、白血病新興治療、溝通技巧相關課程，鼓勵護理師主動積極參與，提升臨床新知、技能以及照顧類似病人的自信，以面對病人日新變異的治療需求。

關鍵字

白血病；復發；化療副作用；敗血性休克；口腔黏膜炎

並列摘要

This article describes a leukemia patient who received allogeneic hematopoietic stem cell transplantation (HSCT), but unfortunately, relapsed within half a year. She was uncertain about the treatment arrangement and experienced severe side effects from chemotherapy. From April 29 to May 28, 2020, a comprehensive assessment was performed of the related physical, psychological, spiritual, and social factors. The data were collected from interviews, observation, physical examination, and chart reviews. Health issues included infection complicated by septic shock, mucositis, and uncertainty. The patient's infection and mucositis were treated successfully and her vital signs were stabilized using appropriate medication and oral hygiene education. Moreover, the causes of uncertainty were clarified through communication, focusing on mindfulness-based stress reduction and relaxation techniques. To mitigate complications, studies recommend planning programs, such as the management of septic shock and novel therapy for leukemia, as well as enhancing communication skills, and encouraging nursing staff participation in the program. Thus, enhancing the knowledge of care, skills, and confidence among nursing staff can help to overcome evolving care needs.

並列關鍵字

leukemia ； relapse ； side effects of chemotherapy ； septic shock ； mucositis

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