經股動脈進行心導管檢查後，哪項評估結果應優先考量？
Which assessment finding is a priority for a client following a cardiac catheterization via the femoral artery?
- AClient reports thirst病人主訴口渴
- BSmall hematoma at the puncture site穿刺部位有小血腫
- CBilateral pedal pulses are 2+雙側足背動脈搏動為 2+
- DThe affected foot is cool and pale✓ 正解患肢冰冷且蒼白
經股動脈進行心導管檢查後，最優先的護理評估是監測穿刺部位遠端的循環狀態。這是因為股動脈是大型動脈，穿刺後有出血、血栓形成或動脈痙攣的風險，可能導致遠端肢體缺血。護理師必須警覺任何肢體灌流不足的徵象，因為這可能導致嚴重的併發症，如肢體壞死。評估的重點應放在受影響肢體（患肢）的顏色、溫度、感覺、運動功能及脈搏（5P原則：Pain, Pallor, Pulselessness, Paresthesia, Paralysis），並與健側肢體進行比較。任何異常都需立即處理，以保護病人肢體功能。
Following cardiac catheterization via the femoral artery, the highest-priority nursing assessment is monitoring circulation distal to the puncture site. Because the femoral artery is a large artery, puncture carries risks of bleeding, thrombus formation, or arterial spasm, which can result in distal limb ischemia. The nurse must remain vigilant for any signs of inadequate limb perfusion, as these can progress to serious complications such as limb necrosis. Assessment should focus on the color, temperature, sensation, motor function, and pulses of the affected extremity (the 5 Ps: Pain, Pallor, Pulselessness, Paresthesia, Paralysis), comparing findings with the unaffected limb. Any abnormality must be addressed immediately to preserve limb function.
心導管術後照護的原則在美國和台灣是相似的，都非常重視穿刺部位的止血與遠端肢體循環的評估。美國的臨床指引會強調更頻繁且持續的監測，特別是術後最初幾小時內，每15分鐘一次，之後逐漸延長間隔。台灣的醫院也遵循類似的監測頻率，但可能因各醫院常規及醫囑而略有差異。兩地護理師都需熟練掌握神經血管評估（neurovascular assessment）技巧，並了解異常發現的緊急處理流程。