病人正因嚴重 MRSA 感染接受萬古黴素（Vancomycin）治療，下列何種評估結果需立即處理？
A client is receiving vancomycin for a severe MRSA infection. Which assessment finding requires immediate nursing intervention?
- ASerum creatinine level increase from 0.8 to 0.9 mg/dL血清肌酸酐濃度由 0.8 上升至 0.9 mg/dL
- BFlushing of the face, neck, and upper torso✓ 正解臉部、頸部及上半身潮紅
- CPresence of a peripheral IV site with no redness周邊靜脈留置針處無紅腫
- DBlood pressure of 110/70 mmHg血壓 110/70 mmHg
萬古黴素（Vancomycin）輸注過程中，若速度過快可能導致組織胺（Histamine）大量釋放，引發紅人症候群（Red Man Syndrome）。這是一種輸注相關反應，而非過敏反應。臨床表現包括臉、頸、胸部潮紅、搔癢及低血壓。護理師需立即停止輸注，評估病人狀況，並通知醫師，通常建議減慢輸注速率或給予抗組織胺處理。
During vancomycin infusion, a too-rapid rate can result in massive histamine release and cause Red Man Syndrome. This is an infusion-related reaction rather than a true allergic reaction. Clinical features include flushing of the face, neck, and chest, pruritus, and hypotension. The nurse must immediately stop the infusion, assess the patient's status, and notify the provider; typical management is to slow the infusion rate and/or administer an antihistamine.
在美國，這類輸注反應通常會由藥師（Pharmacist）與護理師共同檢視輸注速率設定，且護理師依據 protocol 暫停給藥後，必須立即進行 documentation 並通知 Provider。