— 生理適應 · HARD · SATA —
一位病人出現抗利尿激素分泌失調症候群 (SIADH) 症狀，護理師應預期採取哪些措施？（選所有適合的）
A client presents with symptoms of syndrome of inappropriate antidiuretic hormone (SIADH). Which interventions should the nurse anticipate? (Select all that apply.)
- AFluid restriction✓ 正解限制液體攝取
- BAdminister 0.9% Normal Saline輸注 0.9% 生理食鹽水
- CAdminister 3% Hypertonic Saline✓ 正解輸注 3% 高張鹽水
- DMonitor daily weights✓ 正解監測每日體重
- EEncourage high sodium intake鼓勵高鈉飲食
— Explanation · 中文詳解 —
SIADH 會導致水分過度滯留與稀釋性低血鈉。治療核心為水分限制（A）與監測體重（D），若血鈉過低導致神經症狀，則需以高張溶液（3% NaCl）緩慢矯正（C）。普通生理食鹽水（0.9%）在此情況下可能會加重水分滯留。
SIADH causes excessive water retention and dilutional hyponatremia. The cornerstone of treatment is fluid restriction (A) and monitoring of body weight (D). If sodium falls low enough to cause neurologic symptoms, slow correction with hypertonic saline (3% NaCl) is required (C). Ordinary normal saline (0.9%) may worsen water retention in this situation.
✦ 台美臨床差異
3% 高張鹽水給予在兩地皆屬高風險處置，需在加護病房監測且經雙人核對。