— 生理適應 · HARD · MCQ —
一位第一型糖尿病病人送至急診，血糖 450 mg/dL，護理師應優先執行哪項醫囑？
A nurse is caring for a client with type 1 diabetes mellitus who is brought to the ED with a blood glucose level of 450 mg/dL. Which order should the nurse implement first?
- AAdminister IV insulin bolus給予靜脈注射胰島素推注劑量
- BObtain arterial blood gases取得動脈血氣體分析
- CInfuse 0.9% normal saline✓ 正解輸注 0.9% 生理食鹽水
- DAdminister potassium chloride給予氯化鉀
— Explanation · 中文詳解 —
高血糖急症（DKA）的首要處置是水分復甦（Fluid resuscitation）。高血糖造成嚴重的滲透性利尿與脫水，補充生理食鹽水可擴充血管內容積，改善組織灌流，並稀釋血糖濃度。Insulin 必須在確認鉀離子水平且補水後才給予，以免造成低血鉀。
Fluid resuscitation is the first priority in DKA. Hyperglycemia causes severe osmotic diuresis and dehydration; normal saline expands intravascular volume, improves perfusion, and dilutes glucose. Insulin is given only after potassium is verified and volume is replaced to prevent severe hypokalemia.
✦ 台美臨床差異
美台急診對於 DKA 流程相似，皆強調補水優先於使用胰島素。