急性胰臟炎病人最容易出現哪種生理調適方面的併發症?
A client with acute pancreatitis is at highest risk for which complication related to physiological adaptation?
- AMetabolic alkalosis代謝性鹼中毒
- BRespiratory failure呼吸衰竭
- CHypovolemic shock✓ 正解低血容量性休克
- DRenal calculi腎結石
急性胰臟炎(Acute Pancreatitis)會引發全身性發炎反應症候群(SIRS),導致血管通透性增加,大量液體從血管內滲漏至腹膜後腔與第三空間(Third-spacing)。這種「液體轉移」會造成嚴重的循環血量不足,導致低血容量性休克(Hypovolemic shock)。在 NCLEX 的臨床優先順序中,維持組織灌流(Perfusion)是預防多重器官衰竭的關鍵,因此低血容量休克是該病最致命的早期併發症。護理重點在於早期發現生命徵象改變並進行積極的液體復甦。
Acute pancreatitis triggers a systemic inflammatory response syndrome (SIRS), which increases vascular permeability and allows large amounts of fluid to leak from the intravascular space into the retroperitoneum and the third space (third-spacing). This fluid shift leads to severe reduction in circulating volume and produces hypovolemic shock. In NCLEX clinical prioritization, maintaining tissue perfusion is the key to preventing multi-organ failure, making hypovolemic shock the most lethal early complication of this condition. Nursing priorities include early detection of changes in vital signs and aggressive fluid resuscitation.