一位接受腹部子宮切除術後 24 小時的病人，護理師採取哪項措施對預防深部靜脈栓塞 (DVT) 最有效？
A nurse is caring for a client who is 24 hours post-operative following an abdominal hysterectomy. Which action is most effective in preventing deep vein thrombosis (DVT)?
- AEncouraging the client to perform deep breathing exercises鼓勵病人進行深呼吸運動
- BPlacing a pillow under the client's knees for support在病人膝下放置枕頭支撐
- CAssisting the client with early and frequent ambulation✓ 正解協助病人早期且頻繁地行走
- DApplying sequential compression devices (SCDs) while in bed臥床時使用間歇性氣壓壓迫裝置（SCDs）
核心概念：預防術後併發症，特別是靜脈瘀滯。早期下床活動（early ambulation）是預防 DVT 的金標準，因為骨骼肌幫浦的收縮能直接促進血液回流。為何正確答案對：雖然 SCD 很有用，但主動下床活動在循環動力學上的效益更高且更持久。為何其他選項錯：選項 B 在膝下墊枕頭會壓迫膕窩靜脈，反而增加血栓風險；選項 A 主要預防肺塌陷而非 DVT。臨床思路：護理師應優先選擇促進自主生理功能恢復的措施，早期下床不仅預防 DVT，也能促進腸胃蠕動與肺部擴張。
Core concept: prevention of postoperative venous stasis. Early and frequent ambulation is the gold standard for DVT prevention because skeletal muscle pump contraction directly promotes venous return. Although SCDs (D) are useful, active ambulation has greater and more sustained hemodynamic benefit. A pillow under the knees (B) compresses the popliteal vein and increases thrombosis risk. Deep breathing (A) primarily prevents atelectasis rather than DVT. The nurse should prioritize interventions that restore autonomous physiologic function; early ambulation also promotes GI motility and pulmonary expansion.
在美國，護理師對於術後病人何時下床有較大的自主權，通常術後當天即會要求下床；台灣臨床實務上有時會受限於家屬過度保護或管路留置考量，下床時間點相對較晚，需更積極衛教。