病人患心衰竭並服用 Digoxin 與 Furosemide。病人主訴看燈光有黃色光暈。首要護理措施為何？
The nurse is caring for a client with a history of heart failure who is taking Digoxin and Furosemide. The client reports seeing yellow halos around lights. What is the priority nursing action?
- ACheck the client's serum potassium level✓ 正解檢查病人的血清鉀濃度
- BAssess for peripheral edema評估周邊水腫
- CAdminister the next dose of digoxin給予下一劑Digoxin
- DDocument the finding and monitor記錄此發現並繼續監測
Digoxin（強心劑）與 Furosemide（排鉀利尿劑）併用是心衰竭病人的常見組合，但也極具風險。Furosemide 會導致低血鉀（Hypokalemia），而鉀離子與 Digoxin 競爭心肌細胞上的鈉鉀泵受體。當血鉀過低時，Digoxin 會過度結合，顯著增加 Digoxin 中毒（Digoxin Toxicity）的風險。中毒的典型症狀包括：視覺改變（黃綠色光暈）、腸胃道不適（噁心、嘔吐、厭食）以及心律不整（如心搏過緩）。當病人主訴「黃色光暈」時，護理師的臨床思路應立即聯想到「中毒」與「電解質失衡」，並優先檢查血鉀數值，因為糾正低血鉀是緩解毒性的首要關鍵。
The combination of digoxin (a cardiac glycoside) and furosemide (a potassium-wasting diuretic) is common in heart failure but carries substantial risk. Furosemide causes hypokalemia, and potassium competes with digoxin for binding to the sodium-potassium pump on myocardial cells. When serum potassium falls, digoxin binds more avidly, significantly increasing the risk of digoxin toxicity. Classic manifestations of toxicity include visual disturbances (yellow-green halos), gastrointestinal symptoms (nausea, vomiting, anorexia), and dysrhythmias (such as bradycardia). When a client reports 'yellow halos,' the nurse's clinical reasoning should immediately consider toxicity and electrolyte imbalance and prioritize checking the serum potassium, since correcting hypokalemia is the key initial step in mitigating digoxin toxicity.
在美國，Digoxin 的治療範圍通常定為 0.5-2.0 ng/mL，但對於心衰竭病人，臨床更傾向維持在較低範圍（0.5-0.9 ng/mL）。台美護理師都需注意：給藥前必須測量心尖脈（Apical pulse）一整分鐘，若心率 <60 次/分應停藥並回報。