— 基本照護與舒適 · MEDIUM · MCQ —
一位留置鼻胃管的病人，哪項評估發現顯示管路正確置入胃部？
Which assessment finding in a client with a nasogastric (NG) tube indicates that the tube is correctly placed in the stomach?
- AThe client is coughing vigorously病人劇烈咳嗽
- BAspirated gastric contents have a pH of 3.5✓ 正解吸出的胃內容物 pH 值為 3.5
- CThe tube can be easily pulled back 5 cm管路可輕易向後拉回 5 公分
- DAspirated contents are clear and frothy吸出物清澈且呈泡沫狀
— Explanation · 中文詳解 —
確認鼻胃管位置最可靠的黃金標準是胸部 X 光。在無法進行 X 光確認時，吸出胃液測 pH 值是重要依據。胃酸 pH 值通常在 1-5 之間。若出現劇烈咳嗽（選項 A）或吸出物呈泡沫狀（選項 D），則高度懷疑管路誤入氣管。
The gold standard for confirming nasogastric tube placement is a chest X-ray. When X-ray is unavailable, aspirating gastric contents and testing pH is an important measure. Gastric pH is typically between 1 and 5. Vigorous coughing (option A) or frothy aspirate (option D) strongly suggests inadvertent placement into the trachea.
✦ 台美臨床差異
美台皆強調 X 光確認位置，但在床邊測試上，美國醫療院所目前已嚴格禁用「打氣聽診法」，台灣臨床上亦逐漸跟進。