罹患頑固性瀰漫性大型B細胞淋巴瘤年輕女性行異體幹細胞移植焦慮之護理經驗

個案2017年初診斷瀰漫性大型B細胞淋巴瘤，正值懷孕15週，為保全胎兒僅接受類固醇及標靶治療，2018年6月產後開始執行化學治療，因多次治療成效不佳，自覺看不見疾病治癒，對未來產生不確定，治療過程配合度低，對周遭人事相處充滿戒備，且反覆思量質疑醫護人員的指導。於2020年6月個案接受異體造血幹細胞移植期間，依據生理、心理、社會等方面評估分析資料，確立「腹瀉」、「疲憊」、「焦慮」等健康問題，擬定具個別性及整體性之護理計畫，與營養師、藥師、復健師跨領域合作，改善生理不適症狀，善加運用同理心及關懷技巧串聯支持系統，引導正向思考提升因應壓力技巧。建議護理師應適當扮演團隊間良好的溝通橋樑，安排家人共同參與，使個案及照顧者能獲得移植後完善及持續性照護。

關鍵字

瀰漫性大型B細胞淋巴瘤；異體幹細胞移植；焦慮

並列摘要

The patient was diagnosed with diffuse large B-cell lymphoma in early 2017. The patient was 15 weeks pregnant at the time of the diagnosis. To maintain the fetus, she received only steroids and targeted therapy. Chemotherapy was administered immediately after birth in June, 2018. The patient felt that her disease was incurable after multiple treatment failures. She felt uncertain about her future and became uncooperative and defensive. She always questioned doctors' advice and nurses' instructions. In June 2020 Based on patient's physiological, psychological, and spiritual evaluations during her allogeneic hematopoietic stem cell transplantation, , we identified three health problems, including ＂diarrhea,＂＂fatigue,＂ and ＂anxiety,＂. A customized and holistic care plan was proposed involving an interdisciplinary team of dietitian, pharmacists, and rehabilitation practitioners. We made good use of empathy and caring skills to help her develop positive thinking and improved stress management skills. We would recommend that nurses act as a good communication bridge between the clinical care teams and caregivers and help family to involve and engage on patient's care when caring for patients receiving hematopoietic stem cell transplantation.

並列關鍵字

diffuse large B-cell lymphoma ； allogeneic hematopoietic stem cell transplantation ； anxiety

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