護理師照護一位患有嚴重慢性阻塞性肺病（COPD）且主訴入睡困難的病人。護理師應採取哪項措施？
The nurse is caring for a client with severe chronic obstructive pulmonary disease (COPD) who reports difficulty sleeping. Which intervention should the nurse implement?
- AEncourage the client to drink a glass of warm milk before sleep鼓勵病患睡前喝一杯溫牛奶
- BAdminister the prescribed PRN dose of lorazepam at bedtime睡前給予處方之備用劑量 Lorazepam
- CIncrease the oxygen flow rate by 2 L/min during the night夜間將氧氣流量增加2 L/min
- DAssist the client into a high-Fowler's position with pillows to support the arms協助病患採高福氏臥位並以枕頭支撐雙臂正確答案
- D協助病患採高福氏臥位並以枕頭支撐雙臂
重度 COPD 病人夜間難眠多源於端坐呼吸與呼吸費力。D 正確：高坐臥位加枕頭支撐雙臂，能增加肺部擴張空間、減輕橫膈受壓、降低呼吸功，是治本的舒適護理。B 是重大禁忌：benzodiazepine（lorazepam）抑制呼吸中樞，對有 CO2 滯留風險的 COPD 病人可能致命；C 擅自調高氧流量錯誤——理由不是舊教材的「破壞缺氧驅動」，而是 COPD 氧療必須依醫囑滴定到 SpO2 88–92%，未經評估就加 2 L/min 可能誘發 CO2 滯留（通氣灌流失衡與 Haldane 效應），氧療調整需醫囑與血氣評估；A 溫牛奶無實證且不處理呼吸根源。
- A鼓勵病患睡前喝一杯溫牛奶
雖然溫牛奶能幫助放鬆，但對部分呼吸道疾病者來說，乳製品可能讓分泌物變黏，且其改善呼吸的效果遠不如體位調整。
- B睡前給予處方之備用劑量 Lorazepam
對於 COPD 病人，鎮靜安眠藥是非常危險的，因為會抑制呼吸驅動，導致嚴重的二氧化碳蓄積與呼吸衰竭，絕對不是首選介入。
- C夜間將氧氣流量增加2 L/min
隨意調高氧氣流量會破壞 COPD 病人的呼吸代償機制（缺氧驅動），可能導致病人停止呼吸。護理師不可在無醫囑下調整氧氣濃度。
- D · 正確答案協助病患採高福氏臥位並以枕頭支撐雙臂
這是最適合呼吸困難病人的姿勢。支撐雙臂可使用輔助呼吸肌，讓胸廓更易擴張。改善了呼吸，病人自然更容易入睡。
美國 NCLEX 極度重視「呼吸抑制藥物」在肺病病人身上的風險（Safety priority）。台灣臨床上有時會因病人吵鬧而給予輕微鎮靜劑，但在國際考試中，這是必錯選項，護理師必須優先考慮體位與呼吸生理。
English explanation
Sleep difficulty in clients with COPD typically stems from physiologic labored breathing (orthopnea). Placing the client in a high-Fowler's position with pillows supporting both arms increases lung expansion and reduces compression of the diaphragm by the abdominal organs, thereby decreasing the work of breathing; this is the true root-cause comfort intervention. Option B is a major contraindication: benzodiazepines (lorazepam) depress the respiratory center and may cause fatal CO2 retention in COPD clients. Although option A (warm milk) is popular as a sleep aid, milk may increase mucus thickness and is not a first choice. Option C, blindly increasing oxygen, can suppress the hypoxic respiratory drive in COPD. The nurse should use nonpharmacologic measures to improve respiratory mechanics, representing the highest standard of basic care: safe and physiologically appropriate.
最近修訂：2026-10-06