對於急性脊髓損傷病人，下列哪項評估為優先事項？
Which assessment is priority for a client with an acute spinal cord injury?
- ARespiratory status✓ 正解呼吸狀態
- BBladder distention膀胱脹滿
- CDeep tendon reflexes深層肌腱反射
- DSkin condition over the sacrum薦骨部位的皮膚狀況
急性脊髓損傷（Spinal Cord Injury, SCI）的病理生理機制中，受損部位若位於頸部（Cervical）或高位胸椎（Thoracic），會導致支配呼吸肌的神經中斷，引發呼吸衰竭。根據 NCLEX 的 ABC（Airway, Breathing, Circulation）護理優先原則，維持呼吸功能是所有急症護理中的首要任務。呼吸狀態的變化往往發生在損傷後的最初幾小時內，因此必須優先評估呼吸頻率、深度與血氧飽和度，以利及時進行人工氣道建立或呼吸器支持。
In the pathophysiology of acute spinal cord injury (SCI), injuries at the cervical (Cervical) or high thoracic (Thoracic) level can disrupt the nerves that innervate the respiratory muscles, leading to respiratory failure. Based on the NCLEX ABC (Airway, Breathing, Circulation) nursing priority principle, maintaining respiratory function is the top priority in all emergency nursing care. Changes in respiratory status often occur within the first few hours after injury, so respiratory rate, depth, and oxygen saturation must be assessed first to enable timely artificial airway placement or ventilator support.