護理師正在照護一位有酒精使用疾患史的病人。病人出現戒斷症狀，何種症狀需要立即介入？
A nurse is caring for a client with a history of alcohol use disorder. The client is showing signs of withdrawal. Which symptom requires immediate intervention?
- AHallucinations and seizures✓ 正解幻覺與癲癇發作
- BNausea and vomiting噁心與嘔吐
- CTremors顫抖
- DMild anxiety輕度焦慮
酒精戒斷症狀 (Alcohol Withdrawal Syndrome) 是一個連續性的過程。輕度症狀（如焦慮、顫抖、噁心）通常在停止飲酒後數小時內出現，雖不適但通常不會立即危及生命。然而，幻覺（Hallucinations）與癲癇發作（Seizures）代表進入嚴重的戒斷階段，預示著可能發生酒精戒斷譫妄（Delirium Tremens），這是極度危險的醫療緊急狀況，可能導致心血管衰竭或嚴重的腦部損傷，必須立即介入。
Alcohol Withdrawal Syndrome is a continuum. Mild symptoms (such as anxiety, tremors, and nausea) typically appear within hours of cessation; though uncomfortable, they are usually not immediately life-threatening. However, hallucinations and seizures indicate progression to severe withdrawal and forewarn the possible development of delirium tremens, an extreme medical emergency that may lead to cardiovascular collapse or serious brain injury and requires immediate intervention.
在美國臨床環境中，針對酒精戒斷常使用 CIWA-Ar 量表進行嚴格評估。一旦出現幻覺或癲癇，護理師需立即通報並啟動高劑量鎮靜劑（如 Benzodiazepines）治療，流程非常標準化且嚴謹。