護理師照護一位正接受安寧療護且出現嚴重呼吸困難的病人。護理師應首要執行哪項非藥物性的舒適護理措施？
A nurse is caring for a client who is receiving palliative care and experiencing severe dyspnea. Which non-pharmacological comfort measure should the nurse perform first?
- AEncouraging the client to perform deep breathing exercises.鼓勵病人進行深呼吸運動
- BPositioning the client in an upright Fowler's position.將病人置於半坐臥位（Fowler's position）
- CAdministering high-flow oxygen via a non-rebreather mask.透過非再呼吸面罩給予高流量氧氣
- DPlacing a cool fan to blow air across the client's face.✓ 正解放置冷風扇對著病人的臉吹風
在安寧療護（Palliative care）中，舒適是首要目標。針對末期呼吸困難，一個獨特且強而有力的非藥物介入是『風扇療法』。電風扇產生的冷空氣流經面部（特別是三叉神經分佈區），能向大腦傳遞神經信號，降低大腦對呼吸困難的感知，這在實證醫學中被證實對緩解喘感非常有效。雖然坐臥位（B）也很重要，但風扇常能提供更即時的心理與生理緩解。高流量氧氣（C）在安寧階段不一定是首選，除非病人確實有低血氧且氧氣能改善其症狀。深呼吸（A）對於嚴重呼吸困難的病人來說可能太費力，反而增加焦慮。此題考查的是針對特定臨床情境（安寧）的特殊護理知識。
In palliative care, comfort is the primary goal. For end-stage dyspnea, a unique and powerful non-pharmacological intervention is fan therapy. Cool air from a fan moving across the face (particularly across the distribution of the trigeminal nerve) transmits neural signals to the brain that decrease the perception of dyspnea, and this has been shown in evidence-based studies to be very effective in relieving the sensation of breathlessness. Although the Fowler position (B) is also important, a fan often provides more immediate psychological and physiological relief. High-flow oxygen (C) is not necessarily the first choice in palliative care unless the client truly has hypoxemia and oxygen relieves the symptom. Deep breathing (A) may be too exhausting for a severely dyspneic client and may actually increase anxiety. This item tests knowledge specific to the palliative care context.
美國安寧護理強調『症狀管理』而非『延長生命』，風扇療法是安寧護理師常用的標準介入；台灣在安寧推廣上雖已普及，但臨床護理師有時仍會慣性先給予氧氣，而非優先嘗試風扇這類低侵入性的舒適措施。