— 降低風險 · HARD · MCQ —
護理師照護一位有 COPD 病史且正在使用氧氣的病人，哪項發現最令人擔憂？
A nurse is caring for a client with a history of COPD who is on oxygen. Which finding is the most concerning?
- AProductive cough產痰性咳嗽
- BSpO2 of 90%SpO2 為 90%
- CRespiratory rate of 10 breaths per minute呼吸頻率為每分鐘 10 次
- DConfusion and lethargy✓ 正解意識混亂與嗜睡
— Explanation · 中文詳解 —
對於 COPD 病人，意識改變（混亂與嗜睡）是二氧化碳滯留（CO2 narcosis）的徵兆。這代表呼吸衰竭惡化，CO2 在體內過高導致中樞神經抑制。相比之下，SpO2 90% 在 COPD 常見，呼吸頻率輕微下降若不伴隨意識改變則尚可接受，痰液則是慢性病表徵。
In a client with COPD, altered mental status (confusion and lethargy) is a sign of CO2 retention (CO2 narcosis). This represents worsening respiratory failure, as excessive CO2 causes central nervous system depression. By comparison, an SpO2 of 90% is common in COPD, a slightly reduced respiratory rate without altered mental status is generally acceptable, and a productive cough is a chronic baseline finding.
✦ 台美臨床差異
美台對 COPD 的急性呼吸衰竭監測指標一致，均強調意識狀態變化為優先觀察項目。