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生理適應 · HARD · SATA

護理師正在照護一位抗利尿激素分泌不當症候群(SIADH)病人。哪項評估發現最能指示此狀況?(選所有適合的)

A nurse is caring for a client with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which assessment finding is MOST indicative of this condition? (Select all that apply.)

  • ADilute urine (low specific gravity)
    稀釋尿液(低比重的尿液)
  • BConcentrated urine (high specific gravity)✓ 正解
    濃縮尿液(高比重的尿液)
  • CHyponatremia (low serum sodium)✓ 正解
    低血鈉(血清鈉偏低)
  • DHypernatremia (high serum sodium)
    高血鈉(血清鈉偏高)
  • EFluid overload (weight gain, edema)✓ 正解
    液體過載(體重增加、水腫)
Explanation · 中文詳解

SIADH(抗利尿激素分泌不當症候群)是因為 ADH 分泌過多,導致腎臟過度重吸收水分,造成體內水分滯留(dilutional hyponatremia)。臨床表現包括:尿液濃縮(比重高)、血鈉稀釋(低血鈉),以及體液過量徵象(如體重增加、水腫)。護理重點在於限制水分攝取,並監測血鈉與體重變化,以防止低血鈉導致的腦水腫。

Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) is caused by excessive ADH secretion, leading to excessive water reabsorption by the kidneys and water retention in the body (dilutional hyponatremia). Clinical manifestations include concentrated urine (elevated specific gravity), dilutional hyponatremia, and signs of fluid overload (such as weight gain and edema). Nursing care focuses on fluid restriction and monitoring of serum sodium and body weight to prevent cerebral edema caused by hyponatremia.

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