護理師評估一位大面積肺栓塞病人。哪些臨床表現顯示病人正發展為心外阻塞性休克？（選所有適合的）
A nurse is assessing a client with a massive pulmonary embolism. Which clinical findings would indicate that the client is developing obstructive shock? (Select all that apply.)
- AJugular venous distension✓ 正解頸靜脈怒張
- BHypotension✓ 正解低血壓
- CNarrowed pulse pressure✓ 正解脈壓差變窄
- DTachycardia✓ 正解心跳過速
- EPeripheral edema周邊水腫
肺栓塞引起阻塞性休克的機轉在於：肺動脈被巨大血栓堵塞，導致右心室血液無法泵入左心室，引發心輸出量急劇下降。臨床表現上，血流在右心回流處受阻，會出現頸靜脈怒張（A）。心輸出量不足導致全身性低血壓（B）以及代償性的心跳過速（D）。此外，收縮壓下降與代償性交感興奮導致的外周血管收縮，會使得脈壓差變窄（C）。至於周邊水腫（E），雖然是右心衰竭的特徵，但通常見於慢性過程，在急性阻塞性休克的早期並不常見。這題要求考生理解休克的血流動力學變化，而不僅僅是記住肺栓塞的症狀。重點在於識別『心輸出量下降』與『右心前負荷增加』的合併徵象。
In massive PE, obstructive shock develops because a large clot blocks pulmonary arteries, preventing blood from reaching the left heart and causing acute decline in cardiac output. Clinically, backed-up blood causes jugular venous distention (A). Decreased cardiac output leads to systemic hypotension (B) and compensatory tachycardia (D). Falling systolic pressure with sympathetic-mediated peripheral vasoconstriction narrows the pulse pressure (C). Peripheral edema (E), while characteristic of right heart failure, is usually chronic and uncommon in acute obstructive shock. The question tests recognition of decreased cardiac output combined with increased right heart preload.
在美國護理實務中，護理師對於休克分類（心因性、分布性、低血量、阻塞性）的辨識非常強調，這會直接影響到急救藥物的選擇（如是否補水）。台灣臨床則較常將肺栓塞視為呼吸科急症，護理師需提升對休克動力學變化的敏感度，以協助醫師早期識別病情惡化。