— 生理適應 · HARD · MCQ —
一位慢性腎臟病 (CKD) 病人主訴肌肉無力與心悸。心電圖顯示 T 波高尖。哪項處置是最高優先級？
A client with chronic kidney disease (CKD) reports muscle weakness and palpitations. The ECG shows peaked T waves. Which intervention is the highest priority?
- AAdminister oral sodium polystyrene sulfonate給予口服聚苯乙烯磺酸鈉
- BAdminister regular insulin with dextrose給予常規胰島素與右旋糖
- CObtain a serum potassium level取得血清鉀濃度
- DAdminister intravenous calcium gluconate✓ 正解給予靜脈注射葡萄糖酸鈣
— Explanation · 中文詳解 —
心電圖呈現 T 波高尖是嚴重高血鉀造成心律不整的徵兆，具有生命危險。靜脈注射葡萄糖酸鈣的機轉是保護心肌細胞膜，防止致命性心律失常發生，雖然無法降低鉀離子濃度，但能贏得穩定心臟功能的關鍵時間，故為緊急處理的首選。
Peaked T waves on an ECG are a sign of life-threatening arrhythmia caused by severe hyperkalemia. The mechanism of intravenous calcium gluconate is to stabilize the cardiac cell membrane and prevent lethal dysrhythmias; although it does not lower the serum potassium concentration, it buys critical time to stabilize cardiac function, making it the first-line agent in emergency management.
✦ 台美臨床差異
美國醫院常見護理師依據 Standing Order 立即執行鈣劑注射，台灣通常需醫師開立醫囑後執行，但可先準備並呼叫醫師。