護理師評估一位因遭遇火災入院且出現創傷後壓力症候群（PTSD）跡象的病人。護理師預期會發現哪些臨床表現？（選所有適合的）
The nurse is assessing a client who was recently admitted after a house fire and is exhibiting signs of Post-Traumatic Stress Disorder (PTSD). Which clinical manifestations should the nurse expect to find? (Select all that apply.)
- AFlashbacks of the event✓ 正解事件閃回
- BAvoidance of discussing the fire✓ 正解避免討論火災
- CHypervigilance and startle response✓ 正解過度警覺與驚跳反應
- DExcessive sleeping and lethargy過度睡眠與倦怠
- EFeelings of detachment from others✓ 正解與他人疏離感
PTSD 的診斷標準包含三大核心特徵：再體驗、逃避/麻木、過度警覺。選項 A（閃回）是典型的「再體驗」症狀，病人會感覺火災正重新發生。選項 B（逃避討論）與選項 E（情感疏離）屬於「逃避與麻木」，病人試圖避開與創傷相關的刺激，並在心理上與外界隔離以保護自我。選項 C（過度警覺）反應了病人中樞神經系統長期處於高壓備戰狀態。選項 D（過度睡眠）通常不是 PTSD 的典型表現，相反地，病人通常會因噩夢而失眠或睡眠破碎。臨床思路上，護理師需識別這些症狀以提供適當的減敏治療與心理支持，並確保病人感受到環境的安全。治療重點在於處理這些失控感並重建對環境的信任。
PTSD diagnostic criteria include three core features: re-experiencing, avoidance/numbing, and hyperarousal. Option A (flashbacks) is a classic re-experiencing symptom in which the patient feels the fire is occurring again. Option B (avoiding discussion) and option E (emotional detachment) belong to avoidance and numbing, as the patient tries to evade trauma-related stimuli and psychologically isolates to self-protect. Option C (hypervigilance) reflects long-term central nervous system arousal. Option D (excessive sleep) is generally not a typical PTSD finding; rather, patients usually experience insomnia or fragmented sleep due to nightmares. Clinically, nurses should recognize these symptoms in order to provide appropriate desensitization treatment and psychological support, and to ensure the patient feels safe in the environment. Treatment focuses on managing the sense of loss of control and rebuilding trust in the surroundings.
美國對於 PTSD 的篩檢非常普遍，特別是在退伍軍人或災害倖存者中；台灣近年在重大災難（如震災）後也開始重視，但在日常護理評估中，台灣護理師可能較少主動使用結構化的 PTSD 評估量表，而是併入一般心理支持。