一名心臟衰竭病患正在接受靜脈注射 furosemide。下列哪項評估結果最需要護理師向醫師報告？
A client with heart failure is receiving intravenous furosemide. Which assessment finding is the most critical for the nurse to report to the healthcare provider?
- AMuscle weakness and leg cramps✓ 正解肌肉無力與腿部抽筋
- BBlood pressure of 110/70 mmHg血壓 110/70 mmHg
- CUrine output of 60 mL/hr尿量 60 mL/hr
- DDecrease in weight by 1 kg in 24 hours24 小時內體重減輕 1 kg
Furosemide 是強力利尿劑（Loop diuretic），最顯著的副作用是電解質失衡，特別是低血鉀。肌肉無力與小腿抽筋是低血鉀的典型症狀。由於低血鉀會增加心臟衰竭病人發生心律不整或毛地黃中毒（若同時併用 Digoxin）的風險，因此具有臨床急迫性。選項 C 的尿量屬於正常範圍（>30 mL/hr），選項 B 血壓尚在正常區間，選項 D 的體重減輕則是利尿劑發揮預期療效（排出多餘水分）的表現。護理師應敏銳察覺電解質異常的身體徵象，以預防更嚴重的心血管併發症。
Furosemide is a potent loop diuretic, and its most significant side effect is electrolyte imbalance, particularly hypokalemia. Muscle weakness and leg cramps are typical symptoms of hypokalemia. Because hypokalemia increases the risk of dysrhythmias in heart failure clients and digoxin toxicity (if used concurrently), it carries clinical urgency. Option C's urine output is within the normal range (>30 mL/hr), Option B's blood pressure is still within a normal range, and Option D's weight loss represents the intended therapeutic effect of the diuretic (removing excess fluid). The nurse should be alert for physical signs of electrolyte abnormalities to prevent more severe cardiovascular complications.
在美國護理實務中，若發現病患有低血鉀徵兆，護理師通常會直接查看最近的實驗室數值並在通報時一併告知；台灣臨床則多由護理師先測量生命徵象並向醫師回報症狀，再由醫師決定是否加抽電解質。