護理師正為病人進行大腸鏡檢查前的準備。下列哪項實驗室檢驗結果應立即向醫療團隊呈報？
A nurse is preparing a client for a scheduled colonoscopy. Which laboratory result should be reported to the healthcare provider immediately?
- ABlood urea nitrogen (BUN) of 22 mg/dL尿素氮（BUN）為 22 mg/dL
- BWhite blood cell count of 10,500/mm³白血球計數為 10,500/mm³
- CPlatelet count of 45,000/mm³血小板計數為 45,000/mm³正確答案
- DHemoglobin of 11.5 g/dL血紅素為 11.5 g/dL
- C血小板計數為 45,000/mm³
大腸鏡檢查雖然是常規檢查，但過程中若進行息肉切除（polypectomy）或切片，出血風險會顯著增加。血小板計數（Platelet count）正常值為 150,000-400,000/mm³。當血小板低於 50,000/mm³ 時，屬於嚴重血小板低下，會增加自發性出血及侵入性處置後的止血困難。在進行大腸鏡前，護理師必須確認病人的凝血功能。選項 D（血紅素 11.5）略低，但在慢性病或女性病人中常見，非急迫；選項 A（BUN 22）輕微升高，可能與清腸藥物導致的脫水有關；選項 B（WBC 10,500）在正常上限，無急性臨床意義。唯有血小板 45,000 是手術/處置禁忌，必須立即報告以評估是否延後檢查或輸注血小板。
- A尿素氮（BUN）為 22 mg/dL
BUN 22 mg/dL 僅輕微高於正常值（通常至 20），這在服用強力清腸瀉藥後因液體流失而產生的輕度脫水現象中非常普遍，不具急迫性。
- B白血球計數為 10,500/mm³
白血球 10,500/mm³ 處於正常參考範圍上限，若無發燒或腹痛等症狀，並不代表有急性感染風險，無需立即通報。
- C · 正確答案血小板計數為 45,000/mm³
血小板低於 50,000/mm³ 具有高度出血風險。大腸鏡常伴隨切片或息肉切除，若凝血功能不全可能導致腸道大出血，是處置前的重大風險指標。
- D血紅素為 11.5 g/dL
血紅素 11.5 g/dL 雖然稍低，但對於非大手術的大腸鏡檢查而言，並非立即性的禁忌症，不需優先於血小板異常進行報告。
在美國，檢查前的「Time-out」和實驗室數值審核由護理師主導，若數值未達標，護理師有權且有責任暫停流程。台灣則多由醫師在檢查當下確認，但護理師在術前準備室的把關角色正日益受到重視，強調「預防性安全」的概念。
English explanation
Although colonoscopy is a routine procedure, if polypectomy or biopsy is performed, the risk of bleeding increases significantly. The normal platelet count range is 150,000-400,000/mm³. When the platelet count falls below 50,000/mm³, this represents severe thrombocytopenia, which increases both the risk of spontaneous bleeding and the difficulty of achieving hemostasis after an invasive procedure. Before colonoscopy, the nurse must confirm the client's coagulation status. Option D (hemoglobin 11.5) is slightly low but is common in clients with chronic disease or in female clients and is not urgent; option A (BUN 22) is mildly elevated, possibly related to dehydration from the bowel preparation; option B (WBC 10,500) is at the upper limit of normal and has no acute clinical significance. Only the platelet count of 45,000 constitutes a contraindication for the procedure and must be reported immediately to determine whether the procedure should be delayed or whether a platelet transfusion is needed.
最近修訂：2026-05-17