護理師正在照護一位肺炎病人。哪項評估發現需要立即介入？（選所有適合的）
A nurse is caring for a client with pneumonia. Which assessment finding requires immediate intervention? (Select all that apply.)
- AProductive cough with yellow sputum有痰咳嗽伴隨黃色痰液
- BFever of 38.8°C (101.8°F)體溫38.8°C (101.8°F)
- CSudden onset of shortness of breath and decreased SpO2 to 88%✓ 正解突發性呼吸困難且SpO2降至88%
- DIncreased respiratory rate of 28 breaths per minute呼吸頻率增加至每分鐘28次
- EDecreased heart rate to 50 bpm✓ 正解心率減低至每分鐘50次
肺炎病人若突然出現呼吸困難、血氧驟降至 88%（嚴重低血氧），表示氣體交換嚴重惡化，需要立即處理。心率驟降至 50 bpm（心搏過緩）也可能與缺氧、感染影響心臟傳導系統有關，屬於異常情況，需緊急評估。黃痰、發燒、呼吸加快是肺炎常見症狀，但不如呼吸窘迫和心搏過緩緊急。
In a client with pneumonia, sudden onset of dyspnea and a precipitous drop in SpO2 to 88% (severe hypoxemia) indicates a marked deterioration of gas exchange that requires immediate intervention. A sudden drop in heart rate to 50 bpm (bradycardia) may also be related to hypoxia or to infection affecting cardiac conduction; it is abnormal and requires emergent assessment. Yellow sputum, fever, and tachypnea are common manifestations of pneumonia but are not as urgent as respiratory distress and bradycardia.
美國的肺炎處置指引強調早期識別併發症，特別是呼吸衰竭；台灣的照護也重視此點，但病人對呼吸變化的自我察覺與回報很重要。