— 生理適應 · HARD · MCQ —
一位病人呈現低血容性休克徵象，哪項護理措施是優先的？
A client presents with signs of hypovolemic shock. Which nursing intervention is the priority?
- AInsert a nasogastric tube插入鼻胃管
- BAdminister pain medication給予止痛藥物
- CInsert a large-bore intravenous catheter✓ 正解插入大號靜脈導管
- DObtain a complete blood count進行全血細胞計數檢查
— Explanation · 中文詳解 —
低血容性休克（Hypovolemic shock）的病理基礎是循環血量不足，導致組織灌流（Tissue perfusion）受損。護理師的首要任務是建立兩條大號針頭（Large-bore IV）的靜脈通路，以便進行快速輸液復甦（Fluid resuscitation），這是搶救休克最關鍵的搶救步驟。在休克狀態下，維持循環穩定高於所有其他診斷或治療程序。
Hypovolemic shock results from insufficient circulating blood volume, leading to compromised tissue perfusion. The priority nursing intervention is to establish large-bore intravenous access to facilitate rapid fluid resuscitation, which is essential for restoring hemodynamic stability before other diagnostic or therapeutic procedures.