護理師照顧一位暫時性大便失禁的病人。為維持皮膚完整性，護理師應優先採取哪項措施？
A nurse is caring for a client with a temporary fecal incontinence. Which action should the nurse prioritize to maintain skin integrity?
- AApply a moisture-barrier ointment to the perianal skin.✓ 正解於肛周皮膚塗抹防潮屏障藥膏。
- BCleanse the perianal area with soap and hot water after each stool.每次排便後用肥皂和熱水清潔肛周區域。
- CLimit the client's dietary intake of fiber and fluids.限制病人的膳食纖維和液體攝取。
- DApply an absorbent brief and change it every 8 hours.使用吸收性尿布並每 8 小時更換一次。
大便失禁對皮膚最大的威脅是糞便中的消化酶與濕氣造成的化學性刺激（失禁相關性皮膚炎，IAD）。施作皮膚屏障膏或保護膜（A）能在皮膚表面形成物理隔絕層，防止糞便直接接觸受損組織。選項 D（8 小時換一次）太久了，失禁應立即更換。選項 B（肥皂與熱水）會破壞皮膚表面的酸性保護層與油脂，使皮膚更脆弱，應使用弱酸性清洗劑與溫水。選項 C 錯誤，限制纖維與水不能解決失禁問題，反而可能導致便秘後的滲便。護理師應落實「即時清潔+屏障保護」的原則。
The greatest threat to the skin in fecal incontinence is the chemical irritation caused by digestive enzymes and moisture in the stool (Incontinence-Associated Dermatitis, IAD). Applying a skin barrier ointment or protective film (A) creates a physical barrier on the skin's surface, preventing the stool from directly contacting damaged tissue. Option D (changing every 8 hours) is too long; briefs must be changed immediately after each incontinent episode. Option B (soap and hot water) destroys the acid mantle and natural oils on the skin surface, making the skin more fragile; mildly acidic cleansers and warm water should be used. Option C is incorrect because restricting fiber and fluids does not solve incontinence and may instead lead to fecal leakage from constipation. The nurse should follow the principle of "immediate cleansing plus barrier protection."
美國 NCLEX 與臨床非常強調使用「Moisture barrier」以及區分壓瘡與 IAD。台灣臨床對於紅臀常習慣用「烤燈」，但目前實證護理更傾向於使用屏障膏與避免過度曝曬，以維持黏膜水分均衡。