一位骨髓發育不良症候群患者經異體幹細胞移植後併發急性排斥之照護經驗

Nursing Experiences of Caring a Patient with Myelodysplastic Syndrome Receiving Matched Unrelated Allogeneic Peripheral Blood Stem Cell Transplantation with Complications of Severe Acute Graft Versus Host Disease

吳若儒(Jo-Ju Wu)

《腫瘤護理雜誌》 13卷1期 (2013/06) Pp. 63-73

https://doi.org/10.6880/TJON.201306_13(1).07

摘要

本文主要探討一位骨髓發育不良症候群患者經異體幹細胞移植後，併發急性排斥的照護經驗。護理期間由2010年8月17日～8月24日，筆者藉由直接照護、傾聽及會談等技巧建立護病關係，並使用羅氏適應模式進行資料收集及分析，確立個案的護理問題有口腔黏膜改變、皮膚完整性受損、排便型態改變、高危險性感染、不確定感。針對這些問題提供個別化的護理措施，協助個案維持身體舒適感，依循保護性隔離原則避免再度感染。並同理病人及家屬在面臨疾病預後不明情況下，不確定感所帶來的焦慮，適時給予關懷與支持。藉此經驗分享，提供骨髓及幹細胞移植相關單位護理人員作為參考，以期帶給病患及家屬身心方面更完善的照顧。

關鍵字

骨髓發育不良症候群 ； 異體移植 ； 急性移植物抗宿主疾病 ； 護理

並列摘要

Here we presented a patient with myelodysplastic syndrome receiving matched unrelated allogeneic peripheral blood stem cell transplant with complications of severe acute graft versus host disease. The primary care nurse took care of this patient, and his family from August 17 to August 24 in 2010. She established the patient-caregiver rapport, and used Roy's adaptation model as an assessment tool to identify the patient's health problems. The five major health problems were: (1)oral mucosa, impaired ; (2) skin integrity, impaired due to the fragile and breakdown of skin barrier; (3) diarrhea, altered defecation pattern; (4) infection, risk for; (5) uncertainty about therapy options and treatment outcome. According to the problems listed above, the caregiver provided individualized nursing interventions to this patient to maintain his physical and psychological comfort. In order to lower the risk of infection, all the nursing processes were required to fit the principles of protective isolation. By reporting this case, we want to provide the informative and important nursing experiences for staffs working in hematology wards and transplant units about how to take care the patients with myelodysplastic syndrome receiving allogeneic peripheral blood stem cell transplantation with complications of severe acute graft versus host disease. In addition, we hope to offer better nursing care to comfort the patients and their families physically and spiritually.

並列關鍵字

myelodysplastic syndrome ； allogeneic transplantation ； acute graft versus hostdisease ； nursing