護理師正為一位因糖尿病酮酸中毒（DKA）入院的第一型糖尿病病人擬定護理計畫。下列哪些處置是適當的？（選所有適合的）
The nurse is planning care for a client with Type 1 Diabetes Mellitus who is admitted in diabetic ketoacidosis (DKA). Which of the following interventions are appropriate for this client? (Select all that apply.)
- ARapid infusion of 0.9% Sodium Chloride✓ 正解快速輸注 0.9% 氯化鈉
- BContinuous intravenous regular insulin infusion✓ 正解持續靜脈滴注常規胰島素
- CMonitor blood glucose levels every 1 hour✓ 正解每 1 小時監測血糖
- DAdminister bicarbonate if pH is 7.25若 pH 值為 7.25 則給予碳酸氫鈉
- EAdd glucose to the IV fluids when blood glucose reaches 250 mg/dL✓ 正解當血糖達到 250 mg/dL 時在靜脈輸液中添加葡萄糖
DKA 治療的關鍵在於液體復甦、胰島素補充與電解質平衡。首先，大量補液（A）以糾正脫水和低血壓。其次，必須使用短效胰島素（Regular Insulin）連續靜脈滴注（B）以抑制酮體產生，並需每小時監測血糖（C）以精確調整劑量。關鍵轉折點在於當血糖降至 250 mg/dL 左右時，應在點滴中加入 D5W（E），這是為了防止血糖下降過快導致腦水腫，並允許持續給予胰島素來代謝體內的酮體。選項 D 是錯誤的：臨床指引建議只有在 pH < 6.9 時才考慮使用碳酸氫鈉，pH 7.25 應透過胰島素與補液自然恢復。此題考察護理師對 DKA 複雜治療流程的時序性理解，特別是預防治療併發症（如低血糖、腦水腫）的安全性考量。
The key to DKA treatment lies in fluid resuscitation, insulin replacement, and electrolyte balance. First, aggressive fluid replacement (A) is given to correct dehydration and hypotension. Second, a continuous IV infusion of short-acting (regular) insulin (B) is necessary to suppress ketogenesis, and blood glucose must be monitored hourly (C) to precisely titrate the dose. A critical transition point occurs when blood glucose drops to about 250 mg/dL, at which time D5W should be added to the IV fluids (E) to prevent blood glucose from falling too rapidly and causing cerebral edema, while allowing continued insulin administration to metabolize the body's ketones. Option D is incorrect: clinical guidelines recommend bicarbonate only when pH is less than 6.9; a pH of 7.25 should be corrected naturally with insulin and fluid replacement. This question tests the nurse's understanding of the timing of the complex DKA treatment process, particularly the safety considerations for preventing complications of treatment (such as hypoglycemia and cerebral edema).
美國醫學會（ADA）指引對 DKA 治療有標準化的流程圖，護理師需依據血糖值獨立調整胰島素流速與輸液種類；台灣多數醫院亦有類似 protocol，但調整醫囑通常需與醫師密切聯繫，且對於 Bicarbonate 的使用時機在兩國皆趨於保守。