— 照護管理 · EASY · MCQ —
護理師正準備照護一位懷疑感染的病人，應優先採取哪項措施？
A nurse is preparing to care for a client who has a suspected infection. Which action should the nurse take first?
- AInitiate isolation precautions實施隔離防護措施
- BObtain the required culture specimens採集所需的培養檢體
- CAdminister the ordered antibiotic給予處方抗生素
- DAssess the client's vital signs✓ 正解評估病人的生命徵象
— Explanation · 中文詳解 —
護理程序第一步為評估（Assessment）。在處理任何感染症狀前，必須先評估病人的生命徵象，以建立基準線並判斷是否處於敗血症或其他危險狀態。取得檢體或給藥均需依序進行，而若為疑似傳染病，隔離防護亦需依據評估結果決定。
The first step in the nursing process is assessment. Before addressing any symptoms of infection, the nurse must first assess the client's vital signs to establish a baseline and determine whether the client is in sepsis or another dangerous state. Obtaining specimens or administering medications must be performed in sequence, and if a communicable disease is suspected, isolation precautions are decided based on the assessment findings.
✦ 台美臨床差異
台美皆強調護理評估為核心，但美國醫院對於檢體採集與藥物給予流程連結更為自動化。