— 生理適應 · MEDIUM · SATA —
護理師照護一位高血鉀患者，預期應採取哪些處置？（選所有適合的）
A nurse is caring for a client with hyperkalemia. Which interventions should the nurse anticipate as part of the management plan? (Select all that apply.)
- AAdministration of insulin and glucose✓ 正解給予胰島素和葡萄糖。
- BAdministration of calcium gluconate✓ 正解給予葡萄糖酸鈣。
- CInitiation of a potassium-restricted diet✓ 正解開始執行限鉀飲食。
- DAdministration of potassium-sparing diuretics給予保鉀利尿劑。
- EPreparation for potential hemodialysis✓ 正解準備潛在的血液透析。
— Explanation · 中文詳解 —
高血鉀（Hyperkalemia）會嚴重干擾心肌傳導，導致致命性心律不整。治療策略包括：(1) 保護心肌（Calcium Gluconate）；(2) 促進鉀離子進入細胞（Insulin + Glucose）；(3) 限制攝取；(4) 移除過多鉀離子（透析或利尿劑）。護理重點在於監測心電圖（ECG）變化與預防併發症。
Hyperkalemia severely disrupts cardiac conduction and can lead to lethal dysrhythmias. Treatment strategies include: (1) protecting the myocardium (calcium gluconate); (2) shifting potassium into the cells (insulin + glucose); (3) restricting intake; and (4) removing excess potassium (dialysis or diuretics). Nursing care focuses on monitoring ECG changes and preventing complications.