照顧一位急性淋巴性白血病學齡期兒童的護理經驗

Nursing Care of a School-Aged Child with Acute Lymphocytic Leukemia

陳倩芳(Chien-Fang Chen) ； 李麗珠(Lih-Ju Lee) ； 郭碧照(Bih-Jaw Kuo)

《中山醫學雜誌》 14卷2期 (2003/05) Pp. 381-390

https://doi.org/10.30096/CSMJ.200305.0021

摘要

本個案報告探討一位急性淋巴性白血病的學齡期兒童住院期間以語言及非語言方式表達其感受的護理過程。筆者為個案的主護護理師，採Godron十一項功能性健康型態及觀察、會談與圖畫投射方式，評估其生理、心理的需要，將得的資料加以整理分析。結果顯示個案主要的護理問題為(─)白血球低下導致的危險性感染(二)化學治療毒性引起的口腔黏膜改變(三)血小板減少引起的危險性傷害(四)軟弱引起的危險性創傷(五)疾病及治療引起身體心像改變。筆者藉由(一)嚴密性的隔離措施以預防感染(二)正確的口腔護理方法來預防口腔黏膜改變(三)安全防護措施以預防出血(四)漸進式的運動來增加肌肉力量(五)藉由白血病兒童經驗圖誘導出個案對於治療過程中身體心像改變的心理衝擊，再利用遊戲、圖畫投射及同理心之應用，與個案建立良好護病關係，引導及鼓勵個案說出心理感受，使個案從羞澀、沉默不語轉為主動提出疑問及表達內心對疾病及治療的想法與感受，並能積極參與整個照護計劃，改善身體症狀及促進個案住院時之正向行為，順利度過整個住院期。

關鍵字

急性淋巴性白血病 ； 學齡期兒童 ； 圖畫投射 ； 同理心

並列摘要

This case report explores the nursing care for a school-aged child with acutelymphocytic leukemia. Subject verbally and non-verbally expressed his needs and feelings during hospitalization. The authors assessed physiological and psychological needs by observation, interview, picture-projective techniques and Gordon 11 functional health patterns. Primary nursing problems were (1) risk for infection due to leukocytopenia, (2) altered oral mucous membranes due to chemotherapy, (3) risk for injury due to thrombocytopenia, (4) risk for trauma due to weakness and (5) body image changes due to illness and treatment. Absolute protective isolation to prevent infection, special oral care to prevent oral mucosal membrane changes, safety precautions to prevent infection, special oral care to prevent oral mucosal membrane changes, safety precautions to prevent bleeding and progressive exercise training to increase muscular strength were major nursing care interventions. The authors also used picture-drawing to illustrate psychological impulses caused by body image changes. Therapeutic play and empathy were used to establish therapeutic nurse-patient relationships and encourage the child to express his feelings. As a result, the child broke his silence and spontaneously participated in nursing care. His hospitalization was smooth.

並列關鍵字

acute lymphocytic leukemia ； school-aged child ； picture-projective techniques ； empathy