— 生理適應 · MEDIUM · MCQ —
針對腿部打石膏的病人，下列哪項護理評估發現是護理師最必須回報醫師的？
Which assessment finding is most important for the nurse to report to the physician for a client with a cast on their lower leg?
- ASwelling of the toes腳趾腫脹
- BCoolness of the toes腳趾冰冷
- CInability to move the toes✓ 正解無法移動腳趾
- DItching under the cast石膏下搔癢
— Explanation · 中文詳解 —
石膏症候群或腔室症候群（Compartment Syndrome）的五大指標（5Ps）中，活動能力喪失（Paralysis）代表神經損傷已經發生或急性神經壓迫。雖然腫脹或冰冷也需要注意，但「無法活動」通常意味著嚴重的神經或肌腱功能損害，需立即介入處理以防永久性損傷。
Among the five Ps used to monitor for compartment syndrome (or cast syndrome), loss of movement (paralysis) indicates that nerve injury has occurred or that acute nerve compression is taking place. Although swelling or coolness also requires attention, an inability to move usually signifies serious nerve or tendon dysfunction and demands immediate intervention to prevent permanent damage.
✦ 台美臨床差異
美台對於肢體評估（Neurovascular check）的要求相似，但美國更強調護理師直接判斷並依協議執行切石膏操作。