病人預計進行靜脈腎盂造影 (IVP)。護理師的首要評估為何？

靜脈腎盂造影（Intravenous Pyelogram, IVP）是一種使用含碘顯影劑的 X 光檢查，旨在評估腎臟、輸尿管和膀胱的結構與功能。由於檢查過程中會靜脈注射含碘顯影劑，因此病人對碘過敏的風險是護理師在術前必須優先評估的關鍵因素。 對碘或含碘物質（如海鮮）過敏的病人，在接觸顯影劑後可能發生輕度至重度的過敏反應，包括蕁麻疹、呼吸困難，甚至危及生命的過敏性休克。因此，在進行 IVP 前，護理師必須詳細詢問病人的過敏史，特別是藥物、食物（尤其是海鮮）和過去顯影劑反應史。如果病人有相關過敏史，則需要告知醫師，並可能需要調整檢查計畫（如預防性給予抗組織胺或類固醇），或考慮替代的影像檢查方式，以確保病人的安全。

An intravenous pyelogram (IVP) is an X-ray examination using iodinated contrast medium to evaluate the structure and function of the kidneys, ureters, and bladder. Because iodinated contrast is administered intravenously during the examination, the risk of iodine allergy is the most critical preoperative factor the nurse must assess. Clients with allergies to iodine or iodine-containing substances (such as shellfish) may experience mild to severe allergic reactions after exposure to the contrast medium, including hives, dyspnea, and even life-threatening anaphylactic shock. Therefore, before an IVP, the nurse must thoroughly inquire about the client's allergy history, particularly with regard to medications, foods (especially seafood), and any prior reactions to contrast media. If a relevant allergy history is identified, the physician must be notified, and the examination plan may need to be modified (such as prophylactic administration of antihistamines or corticosteroids) or alternative imaging studies considered to ensure the client's safety.

IVP 檢查前評估過敏史的重要性在台灣與美國是完全一致的。兩地護理師都會詳細詢問病人對碘、海鮮或過去顯影劑的過敏反應。在美國，對於有過敏史的病人，預防性給藥（如類固醇和抗組織胺）的標準化流程可能執行得更為嚴格和普遍。台灣護理師也會依醫囑執行預防措施，但核心概念和優先順序並無差異。