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生理適應 · MEDIUM · SATA

一位愛迪生氏症病人因疑似愛迪生氏危機入院。護理師應監測哪些臨床表現?(選所有適合的)

A client with Addison's disease is admitted with a potential Addisonian crisis. Which clinical manifestations should the nurse monitor for? (Select all that apply.)

  • AHypotension✓ 正解
    低血壓
  • BHyperglycemia
    高血糖
  • CHyponatremia✓ 正解
    低血鈉
  • DHyperkalemia✓ 正解
    高血鉀
  • EHypervolemia
    血容量過多
Explanation · 中文詳解

愛迪生氏症(Addison's disease)是一種腎上腺皮質功能不全,其特徵是腎上腺皮質激素(主要是皮質醇, cortisol)和醛固酮(aldosterone)分泌不足。愛迪生氏危機(Addisonian crisis),又稱急性腎上腺危象,是愛迪生氏症的急性惡化,通常由感染、創傷、手術或壓力等誘發,是一種危及生命的緊急情況。由於皮質醇和醛固酮的嚴重缺乏,病人會出現嚴重的低血壓、休克、電解質失衡和低血糖。 護理師必須熟悉愛迪生氏危機的典型臨床表現,以便早期識別並迅速採取行動。醛固酮的缺乏導致腎臟無法有效保留鈉和水,同時排泄鉀,進而引起低血鈉、高血鉀和血容量不足。皮質醇的缺乏則會導致血管張力下降、血糖降低,並影響身體對壓力的反應。這些生理變化共同導致了休克狀態和嚴重的代謝紊亂。

Addison's disease is a form of adrenocortical insufficiency characterized by inadequate secretion of adrenal cortical hormones, principally cortisol and aldosterone. Addisonian crisis, also known as acute adrenal crisis, is an acute exacerbation of Addison's disease typically triggered by infection, trauma, surgery, or stress, and represents a life-threatening emergency. Severe deficiency of cortisol and aldosterone leads to profound hypotension, shock, electrolyte imbalance, and hypoglycemia. Nurses must be familiar with the typical clinical presentation of Addisonian crisis so that they can recognize it early and intervene promptly. Aldosterone deficiency impairs renal sodium and water retention while increasing potassium excretion, causing hyponatremia, hyperkalemia, and hypovolemia. Cortisol deficiency reduces vascular tone, lowers blood glucose, and impairs the body's stress response. Together these physiologic changes produce the shock state and severe metabolic derangements.

✦ 台美臨床差異

愛迪生氏危機的臨床表現和緊急處置原則在台灣與美國是高度一致的。兩地護理師都需監測病人的生命徵象、電解質、血糖,並準備靜脈輸液(生理食鹽水或葡萄糖溶液)和靜脈注射皮質醇(如氫化可體松)。在台灣,對內分泌急症的專科訓練可能集中在大型醫學中心,但在美國,基礎護理教育就已強調這些危急狀況的識別和初步處置。

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