— 藥理與非經腸給藥 · MEDIUM · SATA —
護理師照顧化療病人，應監測哪些藥物外滲（Extravasation）跡象？（選所有適合的）
A nurse is caring for a client receiving chemotherapy. Which signs of extravasation should the nurse monitor for? (Select all that apply.)
- ASwelling around the insertion site✓ 正解穿刺點周圍腫脹
- BBurning sensation reported by the client✓ 正解病人報告灼熱感
- CAbsence of blood return from the catheter✓ 正解導管無法回抽血液
- DIncreased heart rate of the client病人心率增加
- ECoolness or blanching of the skin near the site✓ 正解穿刺點附近皮膚發涼或蒼白
— Explanation · 中文詳解 —
化療藥物外滲會對周邊組織造成嚴重損傷。常見臨床表徵包含：注射部位腫脹、病人自述灼熱感、回抽無血（暗示管路位置偏離）、以及注射部位皮膚蒼白或發涼。心跳過快通常是疼痛或焦慮的全身反應，非外滲診斷的直接特異性指標。
Extravasation of chemotherapy drugs causes serious damage to surrounding tissue. Common clinical manifestations include swelling at the injection site, the patient reporting a burning sensation, inability to aspirate blood (suggesting catheter displacement), and pallor or coolness of the skin at the site. Tachycardia is usually a systemic response to pain or anxiety and is not a specific indicator of extravasation.
✦ 台美臨床差異
美台兩地在化療藥物外滲後的處置流程（如是否需特定解毒劑）高度相似。