— 降低風險 · MEDIUM · MCQ —
護理師評估病人的周邊神經血管功能，下列哪項發現需要立即關注？
A nurse is assessing a client for potential peripheral neurovascular impairment. Which findings indicate a need for immediate concern?
- ASkin is warm to the touch皮膚觸摸溫熱
- BPeripheral pulses are palpable可捫及周邊脈搏
- CCapillary refill time of 2 seconds微血管回充時間為 2 秒
- DThe client reports numbness and tingling✓ 正解病人報告麻木與刺痛感
— Explanation · 中文詳解 —
神經血管評估（6P's）中，麻木（paresthesia）與刺痛感（tingling）是神經受損的早期徵象。若出現此類症狀，代表肢體可能因腫脹或敷料過緊壓迫神經，需立即處理以防止永久性損害。其他選項均為正常發現。
Within the neurovascular assessment (the 6 P's), numbness (paresthesia) and tingling are early signs of nerve injury. The appearance of such symptoms indicates that swelling or a tight dressing may be compressing the nerves of the limb, requiring immediate intervention to prevent permanent damage. The other options are all normal findings.
✦ 台美臨床差異
兩地均極度重視術後或骨科病人的神經血管評估，這是護理評估中的紅旗（Red Flag）指標。