下列哪些病人屬於跌倒高危險群？（選所有適合的）

核心概念：跌倒（falls）是老年人（older adults）住院期間常見且可能導致嚴重傷害（如骨折、頭部外傷）的意外事件。識別跌倒高風險群體並採取預防措施是護理安全的首要任務。 為何正確答案 A, B, D, E 對： A. 75 歲患有姿勢性低血壓（A 75-year-old with orthostatic hypotension）：年齡（≥65歲）本身就是跌倒風險因子。姿勢性低血壓（Orthostatic hypotension）意味著病人從臥姿或坐姿站起時，血壓會顯著下降，導致頭暈、虛弱，極易跌倒。 B. 接受靜脈注射利尿劑（A client receiving IV furosemide for heart failure）：利尿劑（如 Furosemide，一種強效利尿劑）會增加尿液排出量，可能導致頻尿（urinary frequency）和尿急，增加病人需要緊急如廁的次數，尤其在夜間，若行動不便或意識不清，容易在前往廁所途中跌倒。此外，過度利尿也可能導致電解質失衡和低血壓。 D. 有混亂及頻尿病史（A client with a history of confusion and urinary frequency）：認知功能障礙（如混亂、譫妄）會影響病人的判斷力、空間感和對環境的警覺性，使其難以識別危險。頻尿則如 B 項所述，增加如廁跌倒的風險。 E. 使用助行器可自行行走（A client who is ambulatory with a cane）：雖然使用助行器（如助行器 cane 或拐杖）表示病人需要輔助才能行走，但這本身就代表其平衡能力或下肢力量較弱，若再加上其他風險因子（如上述的姿勢性低血壓、視力不佳、藥物副作用等），使用輔助器材反而是跌倒風險增高的表現，而非保護因子。 為何選項 C 錯： C. 20 歲脛骨骨折病人（A 20-year-old client with a fractured tibia）：此病人年輕，通常生理功能較健全，跌倒風險相對較低，除非合併其他嚴重的潛在疾病或藥物影響。單純的下肢骨折，若能穩定且可自行行走（即使需輔助），其跌倒風險通常低於上述老年人或有特定健康問題的病人。 臨床思路/安全優先：跌倒預防的關鍵在於識別高風險因子，並據此採取個別化的介入措施。對老年人、有認知障礙、心血管問題（如低血壓）、使用特定藥物（如利尿劑、鎮靜劑）、行動不便或有跌倒史的病人，應給予額外的關注和安全照護（如加強環境安全、定時巡視、協助如廁、使用防滑設備等）。

Core concept: Falls are common accidents during hospitalization in older adults and can result in serious injury (such as fracture or head trauma). Identifying high-risk groups for falls and implementing preventive measures is a top nursing priority. Why correct answers A, B, D, and E are correct: A. A 75-year-old with orthostatic hypotension: Age (>=65) is itself a fall risk factor. Orthostatic hypotension means the patient's blood pressure drops significantly when rising from a lying or sitting position, leading to dizziness, weakness, and an increased risk of falling. B. A client receiving IV furosemide for heart failure: Diuretics (such as furosemide, a potent diuretic) increase urine output, possibly leading to urinary frequency and urgency, increasing the number of urgent trips to the toilet, especially at night. If mobility or consciousness is impaired, falls easily occur on the way to the toilet. In addition, excessive diuresis may cause electrolyte imbalance and hypotension. D. A client with a history of confusion and urinary frequency: Cognitive impairment (such as confusion, delirium) affects the patient's judgment, spatial awareness, and environmental alertness, making it difficult to identify hazards. Urinary frequency, as in option B, increases the risk of toileting-related falls. E. A client who is ambulatory with a cane: Although the use of a walking aid (such as a cane or crutches) indicates that the patient needs assistance to walk, this itself reflects weaker balance or lower-limb strength. When combined with other risk factors (such as the orthostatic hypotension above, poor vision, or medication side effects), the use of assistive equipment actually reflects an increased fall risk rather than acting as a protective factor. Why option C is wrong: C. A 20-year-old client with a fractured tibia: This patient is young and generally has intact physiological function, so the fall risk is relatively low, unless complicated by other serious underlying disease or medication effects. A simple lower-limb fracture, if the patient is stable and able to ambulate (even with assistance), usually carries a lower fall risk than the older adults or patients with specific health problems described above. Clinical reasoning/Safety priority: The key to fall prevention lies in identifying high-risk factors and implementing individualized interventions accordingly. Extra attention and safety care should be given to older adults, patients with cognitive impairment, cardiovascular problems (such as hypotension), those taking specific medications (such as diuretics or sedatives), patients with limited mobility, or those with a history of falls (such as strengthening environmental safety, scheduled rounds, assistance with toileting, and use of non-slip equipment).