— 安全與感染控制 · MEDIUM · SATA —
在長照機構中，護理師應優先預防哪些病人跌倒？（選所有適合的）
Which of the following clients should the nurse prioritize to prevent falls in a long-term care setting? (Select all that apply.)
- AClient on antihypertensive medication✓ 正解服用抗高血壓藥物的病人
- BClient with a history of a recent fall✓ 正解近期有跌倒史的病人
- CClient with visual impairment✓ 正解視力障礙的病人
- DClient experiencing urinary frequency✓ 正解出現頻尿症狀的病人
- EClient who is alert and oriented意識清楚且定向力完整的病人
— Explanation · 中文詳解 —
跌倒風險評估（如 Morse Fall Scale）包含多項指標。服用降壓藥易引發姿態性低血壓；有跌倒史者再次跌倒機率高；視覺障礙影響環境判斷；頻尿者因夜間需多次如廁，大幅增加風險。警覺且定向力清楚者相對跌倒風險較低。
Fall risk assessment (e.g., the Morse Fall Scale) encompasses multiple indicators. Antihypertensive medications can readily induce orthostatic hypotension; clients with a history of falls have a high probability of falling again; visual impairment affects environmental judgment; and clients with urinary frequency are at greatly increased risk because of multiple nighttime trips to the toilet. Clients who are alert and oriented have a relatively lower fall risk.
✦ 台美臨床差異
美台對跌倒評估工具的使用非常普遍，皆強調針對高風險病人實施分級預防措施。