一位有心衰竭病史的患者因呼吸短促與肺部囉音入院。護理師觀察到患者咳出粉紅色泡沫痰。應預期優先給予哪種藥物？
A client with a history of heart failure is admitted with shortness of breath and crackles in the lungs. The nurse notes the client is coughing up frothy, pink-tinged sputum. Which medication should the nurse expect to administer first?
- AOral Spironolactone口服螺內酯（Spironolactone）
- BIntravenous Furosemide✓ 正解靜脈注射呋塞米（Furosemide）
- CIntramuscular Epinephrine肌肉注射腎上腺素（Epinephrine）
- DSubcutaneous Heparin皮下注射肝素（Heparin）
此病人表現出急性肺水腫（Acute Pulmonary Edema）的典型徵象，這是左心衰竭惡化導致的急症。粉紅色泡沫痰是由於左心室無法有效泵血，導致血液回流至肺微血管，壓力過大使紅血球與液體滲入肺泡。處置重點是「利尿、減輕負荷」。靜脈注射速尿（Furosemide/Lasix）起效極快，能迅速排出體液，降低前負荷（Preload），緩解肺部充血。選項 D（肝素）用於防血栓，非急性水腫處置。選項 A（螺內酯）是弱利尿劑，且只有口服劑型，起效慢，不適合急救。選項 C（腎上腺素）用於過敏性休克，會增加心臟負擔，對心衰竭有害。臨床上，護理師應立即抬高床頭、給氧，並準備執行利尿劑醫囑。這題的核心是識別急性心衰竭的急救用藥原則。
This patient is presenting with the classic signs of acute pulmonary edema, an emergency precipitated by decompensated left-sided heart failure. Pink, frothy sputum results from the left ventricle's inability to pump effectively, causing blood to back up into the pulmonary capillaries with sufficient pressure to force red blood cells and fluid into the alveoli. Management focuses on 'diuresis and afterload/preload reduction.' Intravenous furosemide (Lasix) has a rapid onset and quickly removes excess fluid, reducing preload and relieving pulmonary congestion. Option D (heparin) is for thromboprevention, not for treating acute edema. Option A (spironolactone) is a weak diuretic available only orally and has a slow onset, making it unsuitable for emergencies. Option C (epinephrine) is used in anaphylaxis and would increase cardiac workload, worsening heart failure. Clinically, the nurse should immediately elevate the head of the bed, provide oxygen, and prepare to administer the diuretic as ordered. The core principle in this question is recognition of emergency medication management for acute heart failure.
在美國，急性肺水腫處置常遵循「LMNOP」口訣（Lasix, Morphine, Nitroglycerin, Oxygen, Position）。台灣臨床指引亦類似，但 Morphine 的使用在兩地皆因呼吸抑制風險而變得較為謹慎，Lasix 始終是第一線共識。美國護理師常在急診 Protocol 下具備較高的預先給藥權限。