The nursing care of leucocytopenia
白細胞低下的護理
Nurse: Good morning, Mrs. Zhang. I am your nurse. My name is Amy. After receiving chemotherapy, Your white blood cell （WBC）counts are 0.98*G/L today. It means that you are easily to be infected . Therefore, you need to receive protective isolation. Now you must live in a bed with a laminar air flow system to give you protective isolation procedures. Your bedding, clothing, and pillowcase are will be changed that are disinfected and clean.
護士: 早上好，張小姐，今天我是你的責任護士艾米。你化療後的白細胞數是0.98*G/L。這意味著你容易被感染，所以你需要保護性隔離。我們的層流床將為你提供保護。你的寢具，患服，被套都將會嚴格消毒。
Patient: Oh, I hate it. It is so terrible. What should I do? Anythings should I pay attention to? I want to know more about my therapy.
病人:天吶，我討厭這樣，太恐怖了。我應該做什麼和注意什麼。我想了解更多關於治療相關的事情。
Nurse: Do not worry or feel sad. We can do our best to help you. First, I will give you colony-stimulating factors as prescribed to help your bone marrow to produce WBC. Second, we will limit the number of people entering your room to reduce the risk of cross-infection. All staff and visitors with known infections or exposure to communicable disease are forbidden to contact with you until the risk of infection has passed. Third, the common sites of infection are the skin, respiratory tract and gastrointestinal tract. You should wear the mask and should wash hands necessarily and daily bathing. Eliminating raw fruits and vegetables from the diet. No fresh flowers and live plants in your room. Initiate a bowel program to prevent constipation.Assess urine for cloudiness and other characteristics of infection .Assess skin and oral mucous membranes for signs of infection. We will monitor your temperature, WBC, and neutrophil counts everyday. If the sign of infection are present, you will be administered prescribed antibiotic, antifungal, andantiviral medication.
護士:不要擔心，恐懼或者焦慮。我們會盡力幫你的。首先我會遵醫囑給你使用集落刺激因子來幫你的骨髓升白細胞。第二，會限制探視，包括工作人員的進入，限制有感染者或者有感染可能的人，包括工作人員及探視者，直到感染風險不存在。第三，常見容易感染的部位有皮膚，呼吸道，胃腸道。所以，你需要戴口罩，必要時洗手經常洗澡。不要吃新鮮未加工的水果和蔬菜。在你的房間裡不要放花或者植物。關注排便，保持大便通暢，避免便秘。評估觀察尿液，看有無異常。評估觀察皮膚口腔黏膜有無感染。我們會每天監測你的體溫和白細胞，嗜中性粒細胞細胞計數。如果有感染，我們會遵醫囑使用抗生素，抗真菌，抗病毒藥。
Patient: Yes, I get it. I want to know more about my diagnosis and the treatment strategies.
病人: 好的，我知道了。我想知道更多關於治療方面的知識。
Nurse: Yes, your diagnosis is diffuse large B cell lymphoma (DLBCL)with stage I. DLBCL is the most common subtype in NHL. It is an important type of NHL not only because of its frequency, but also because it is potentially curable. Patients with early stage DLBCL usually receive RCHOP alone or with involved field radiotherapy (IFRT). R-CHOP(Rituximab, cyclophosphamide, adriamycin,vincristine,prednisone)regimen chemotherapy is the standard treatment of DLBCL, which was confirmed to be effective. Patients with stages I/II DLBCL usually received 4–6 cycles of RCHOP followed by radiotherapy, All of these drugs were given intravenously on day 1 of a 21/d cycle. Prednisone was given orally on day 1–5. After chemotherapy, the WBC counts may be extremely low during the period of myelosuppressive phase.
護士: 您的診斷是瀰漫大B細胞淋巴瘤的Ⅰ期。瀰漫大B細胞淋巴瘤是非霍奇金淋巴瘤常見的類型。它是重要的非霍奇金淋巴瘤，是因為它常見，還因為潛在的治癒性可能。早期瀰漫大B細胞淋巴瘤治療方案是單獨RCHOP方案或者聯合放療。R-CHOP方案（包括利妥昔單抗，環磷醯胺，阿黴素，長春新鹼，潑尼松）是瀰漫大B細胞淋巴瘤的標準方案。Ⅰ期和Ⅱ期的瀰漫大B細胞淋巴瘤患者一般做4-6個周期化療，潑尼鬆口服1-5天，其餘靜脈給藥。21天為1個周期。化療後發生骨髓抑制，白細胞可能會降極低。
Patient: Thanks，I feel safety , and so hopeful, now.
病人: 謝謝你，我現在感覺很安全，充滿了希望。
Nurse: You are welcome, by the way, the 2019 novel Coronvirus are epidemic, just be careful. You are safe in the laminar flow bed. According to my experience, when your blood counts are normal, you will be discharged.
護士: 不用謝，順便說一下，新冠病毒還在流行，還是需特別小心。你待在層流床裡是安全的。以我的經驗，當你的血檢驗項目結果正常時，你就出院了。
Patient: Thank you very much.
病人: 非常感謝！
Nurse: You are welcome. I will be with you.
護士: 不客氣。隨時找我，我一直在。
參考文獻：
1.Evaluation to the chemotherapy use in patients with diffuse large B-cell lymphoma.
2.A phase II trial of RCHOP followed by radioimmunotherapy for early stage (stages I/II) diffuse large B‐cell non‐Hodgkin lymphoma: ECOG3402
錄音：辛 萍 範 會
—END—
監製：張濤 楊坤禹
信息來源： 腫瘤中心護理英語沙龍
作者：L6淋巴瘤科
審稿：劉紅利 李娟 朱芳
編輯製作：夏忞婧
轉載請註明來源
部分圖片來源網絡
武漢協和醫院腫瘤中心簡介：
協和醫院腫瘤中心位於武漢市江漢區馬場路109號，1987年在協和醫院本部組建，2002年異址擴建。近20多年來，在多名中心領導包括伍鋼教授、張濤教授、楊坤禹教授帶領下，逐漸發展成設有腫瘤科8個專科（包括頭頸腫瘤、胸部腫瘤、腹部腫瘤、婦科及泌尿生殖系統腫瘤、淋巴瘤、乳腺腫瘤、骨軟組織腫瘤放化療科和放療中心）共16個病區、腫瘤外科4個病區（包括胸部腫瘤、腹部腫瘤、乳腺甲狀腺腫瘤、骨軟組織腫瘤）、日間診療、中西醫結合等專業單元的綜合性腫瘤專科醫院。腫瘤科現年門診量達14.3萬餘人次，年出院人數過6萬，日放療患者近500人次，年放射治療患者超6000餘例。2008年以來獲批國家級科研項目100餘項,發表SCI論文近400篇，獲得各類科研經費逾八千萬。是國家藥品監督管理局臨床藥理試驗基地，教育部「腫瘤侵襲轉移和生物靶向治療」重點實驗室建設單位、博士學位授權點和博士後科研工作流動站，是國家衛健委腫瘤學臨床重點專科建設單位、國家腫瘤放射治療專業住院醫師規範化培訓基地、國家衛健委能力建設和繼續教育腫瘤學專家委員會副主任委員和中國醫師協會腫瘤放射治療分會副會長單位，也是十三五規劃教材《放射腫瘤學》、英文版腫瘤學《Oncology》副主編單位。
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