病人被開立抗膽鹼藥物。護理師應警告病人哪些症狀？（選所有適合的）

抗膽鹼藥物（anticholinergic medication）藉由阻斷毒蕈鹼受體（muscarinic receptor），拮抗副交感神經系統的作用。由於副交感神經負責促進腺體分泌、平滑肌收縮、心率減慢等功能，一旦被阻斷，便會出現一系列「對立」效應。臨床上常見的抗膽鹼藥物包括 atropine、scopolamine、benztropine、oxybutynin、diphenhydramine（抗組織胺兼具抗膽鹼效果）等。 記憶抗膽鹼副作用最經典的英文口訣是：「Blind as a bat（視力模糊）、Dry as a bone（口乾／皮膚乾燥）、Red as a beet（皮膚潮紅）、Mad as a hatter（意識混亂）、Hot as a hare（體溫升高）」。除此之外，還應特別記住泌尿道及腸胃道的影響。 臨床思路方面，護理師在給藥前應先評估病人是否有攝護腺肥大（benign prostatic hyperplasia, BPH）、青光眼（glaucoma）、腸阻塞或心律不整等禁忌症，因為抗膽鹼藥物會加重這些病情。對於老年病人更需特別謹慎，根據 Beers Criteria，多種抗膽鹼藥物被列為高風險藥物，容易引發認知功能下降、跌倒及急性尿滯留。 護理衛教重點包括：建議病人隨身攜帶無糖口香糖或頻繁小口補水以緩解口乾；避免長時間暴露於高溫環境，因排汗減少會影響散熱；提醒視力模糊期間勿駕車或操作機械；注意排便及排尿情形，若超過一定時間未解尿應立即回報。五個選項均為公認的抗膽鹼副作用，因此本題所有選項皆正確。

Anticholinergic medications block muscarinic receptors and antagonize the parasympathetic nervous system. Because the parasympathetic system promotes glandular secretion, smooth muscle contraction, and slowing of the heart rate, blocking it produces a series of opposing effects. Commonly used anticholinergics include atropine, scopolamine, benztropine, oxybutynin, and diphenhydramine (an antihistamine with anticholinergic activity). The classic mnemonic for remembering anticholinergic side effects is: "Blind as a bat (blurred vision), Dry as a bone (dry mouth/dry skin), Red as a beet (flushed skin), Mad as a hatter (confusion), Hot as a hare (elevated temperature)." In addition, the urinary and gastrointestinal effects must be specifically remembered. Clinically, before administration the nurse should assess the client for contraindications such as benign prostatic hyperplasia (BPH), glaucoma, intestinal obstruction, or arrhythmias, because anticholinergic medications can worsen these conditions. Extra caution is warranted in older adults; according to the Beers Criteria, many anticholinergic agents are classified as high-risk and may cause cognitive decline, falls, and acute urinary retention. Key patient education includes: recommending that the client carry sugar-free gum or sip water frequently to relieve dry mouth; avoiding prolonged exposure to hot environments because decreased sweating impairs heat dissipation; reminding the client not to drive or operate machinery while experiencing blurred vision; and monitoring bowel and bladder function, reporting promptly if the client has not voided after a certain interval. All five options are recognized anticholinergic side effects, so every option in this question is correct.

台灣臨床上 diphenhydramine（苯海拉明）常作為過敏或助眠用途，但其抗膽鹼副作用在台灣的衛教說明相對不足，尤其針對老年病人的風險提醒較少強調。美國則廣泛應用 Beers Criteria 作為老年用藥安全指引，明確將多種抗膽鹼藥物列為應避免或謹慎使用的藥物，護理師在用藥審查（medication reconciliation）時扮演更積極的角色。台灣護理師赴美執業時應熟悉此準則。