一位患有急性心臟衰竭惡化的病人，其腦鈉肽 (BNP) 水平為 900 pg/mL，且出現呼吸短促。護理師應優先執行哪項醫囑？
A client with acute exacerbation of heart failure has a brain natriuretic peptide (BNP) level of 900 pg/mL and is experiencing shortness of breath. Which physician order should the nurse implement first?
- ATeach the client about sodium restriction教導病人關於限制鈉鹽攝取
- BDraw blood for electrolyte levels抽取血液檢測電解質濃度
- CObtain a portable chest X-ray安排床邊胸部X光檢查
- DAdminister Furosemide 40 mg IV push✓ 正解靜脈推注注射 Furosemide 40 mg
心臟衰竭急性發作的核心機轉是體液容積過負荷導致肺淤血，進而影響氣體交換。BNP 是心室過度擴張時釋放的酵素，正常值應小於 100 pg/mL，900 pg/mL 顯示嚴重的心衰竭。護理優先順序應遵循 ABC（呼吸、循環）原則。給予靜脈注射利尿劑（Furosemide）能迅速減少循環血量與前負荷（Preload），直接緩解肺水腫引發的呼吸短促。雖然胸部 X 光（C）能輔助診斷，抽血（B）能監測電解質，但這些都不能即時解決病人的缺氧與呼吸困難。衛教（A）屬於穩定後的護理作為，在急性期不具優先性。臨床思路上，護理師應先「處理」威脅生命的生理徵象，再進行「診斷」與「教育」。
The core mechanism of acute decompensated heart failure is fluid volume overload causing pulmonary congestion and subsequent impairment of gas exchange. BNP is an enzyme released when the ventricles are excessively stretched; the normal value should be less than 100 pg/mL, and a value of 900 pg/mL indicates severe heart failure. Nursing priorities should follow the ABC (breathing, circulation) principle. Administering an intravenous diuretic (furosemide) rapidly reduces circulating volume and preload, directly relieving the dyspnea caused by pulmonary edema. Although a chest X-ray (C) aids in diagnosis and laboratory testing (B) monitors electrolytes, neither immediately addresses the client's hypoxia and respiratory distress. Patient education (A) is a stabilization-phase nursing action and is not a priority during the acute phase. Clinically, the nurse must first treat life-threatening physiologic signs before pursuing diagnosis and education.
在美國護理實務中，護理師通常根據醫院的『Standing Orders』，在 BNP 顯著升高且有明顯症狀時，可快速啟動利尿劑治療；台灣臨床則高度依賴住院醫師或主治醫師現場看過病人後才下達 IV 推藥指令，護理師的自主調整空間相對較小。