一位55歲女性在成功完成全膝關節置換術後準備出院。醫師為其開立了雙側抗血栓彈性襪 (TED hose) 以積極預防術後的深部靜脈栓塞 (DVT)。個案對於襪子極端緊繃感到抱怨，並問護理師：「我能不能就像捲一個小甜甜圈一樣，把襪子最頂端往下捲到我的膝蓋下面，這樣感覺比較涼快也沒有那麼緊縮？」護理師最具臨床斷言與正確性的回應為何？
A 55-year-old female is being discharged following a successful total knee arthroplasty. The provider prescribed bilateral anti-embolism stockings (TED hose) to aggressively prevent postoperative deep vein thrombosis (DVT). The client complains regarding the extreme tightness and asks the nurse, "Can I just roll the top down like a little donut ring below my knee so it feels cooler and less restrictive?" What is the nurse's most clinically assertive and correct response?
- A“Yes, making yourself comfortable is the absolute priority; just ensure the rolled portion does not become completely wet.”「是的，讓自己舒適絕對是首要之務；只要確保捲起的部位不會完全弄濕即可。」
- B“No, rolling the stockings creates a tight tourniquet effect, which will dangerously block your blood flow and actually cause blood clots rather than prevent them.”✓ 正解「不行，將襪子捲起會產生緊迫的止血帶效應，這會危險地阻礙您的血流，實際上會導致血栓形成而非預防。」
- C“We recommend cutting a small slit at the top band with scissors instead of rolling them down to physically relieve the elastic pressure.”「我們建議改用剪刀在襪口處剪一小缺口，以物理方式減輕彈性壓力，而不是將其捲下。」
- D“You can roll them down only during the daytime when you are walking, but they must be pulled up tightly during sleep.”「您可以在白天走路時將它們捲下，但在睡覺時必須將其拉緊。」
本題測驗基礎活動防護：抗血栓彈性襪 (Anti-embolism stockings / TED hose) 的禁忌。這種彈性襪依賴經過嚴密計算的「漸進式壓迫 (Graduated compression)」將周邊靜脈血液強迫推回中樞心臟，藉此防堵血液淤積成 DVT。教育病患的核心安全條款是：襪身必須完全平滑無皺褶（Smooth and wrinkle-free）。如果病患將頂部的襪子像甜甜圈一樣「向下捲起束成一圈 (Rolling them down)」，那個聚集的區域在物理上會立刻變成一條強制綁緊的「止血帶 (Tourniquet)」。這個止血帶效應會直接死命勒住小腿的靜脈網與動脈幹，阻斷血流回流，不但徹底摧毀了防栓塞的目的，更會『誘發』災難性的下肢缺血壞死與更嚴重的深層血栓。因此選項B是唯一正確且具備科學威脅性的警告。選項A及D允許了這種致命的操作；選項C教導剪破醫療級加壓襪會瞬間解除其特定壓力的設計初衷，直接讓它變成破布。
This question tests a basic mobility-protection concept: contraindications for anti-embolism stockings (TED hose). These stockings rely on precisely calibrated graduated compression to mechanically push peripheral venous blood back toward the central circulation, thereby preventing blood from pooling and forming a DVT. The core safety teaching for clients is that the stocking must lie completely smooth and wrinkle-free. If the client rolls the top down into a donut-shaped band, that constricted area immediately creates a tourniquet effect. The tourniquet effect physically strangulates the venous and arterial vessels of the lower leg, obstructs venous return, defeats the entire purpose of DVT prophylaxis, and may actually induce catastrophic lower-limb ischemia, necrosis, and more serious deep vein thrombosis. Option B is therefore the only correct and clinically assertive warning. Options A and D permit this dangerous maneuver, and option C, which suggests cutting the medical-grade compression stocking, immediately destroys the calibrated graduated compression mechanism and renders the garment essentially useless.
世界通用基礎護理學防護。不論是在台灣病房或美國，「彈性襪絕對不能有一絲皺褶或往下捲」這句話被視為與「推血壓帶前要先排空空氣」一樣的不可破滅之規則。