護理師照護化療引發血小板減少症的病人。下列哪些護理措施是適當的?(選所有適合的)
A nurse is caring for a client receiving chemotherapy. Which interventions should the nurse include for a client with thrombocytopenia? (Select all that apply.)
- AUse an electric razor for shaving✓ 正解使用電動刮鬍刀剃鬚
- BAdminister aspirin for pain relief給予阿斯匹靈緩解疼痛
- CUse a soft-bristled toothbrush✓ 正解使用軟毛牙刷
- DAvoid activities that can cause injury✓ 正解避免可能導致受傷的活動
- ECheck for signs of occult bleeding✓ 正解檢查是否有隱性出血跡象
血小板低下(血小板減少症)導致凝血異常,護理目標為「預防出血」。選項 B 錯誤:阿斯匹靈會抑制血小板凝集,禁忌使用。應鼓勵軟毛牙刷(避免牙齦出血)、電動刮鬍刀(防割傷)、預防碰撞活動,並監測皮膚瘀斑、血尿、黑便等隱性出血徵象。
Thrombocytopenia (low platelet count) causes abnormal coagulation, and the nursing goal is bleeding prevention. Option B is incorrect: aspirin inhibits platelet aggregation and is contraindicated. The nurse should encourage the use of a soft-bristled toothbrush (to avoid gingival bleeding), an electric razor (to prevent cuts), and avoidance of contact activities, and should monitor for ecchymoses, hematuria, melena, and other signs of occult bleeding.
兩地護理標準一致,台灣臨床常提醒病人禁食阿斯匹靈或含類阿斯匹靈成分的中藥。