一名 45 歲第一型糖尿病病人出現庫斯莫爾氏呼吸（Kussmaul）、呼吸有水果味，血糖 480 mg/dL。護理師應優先採取何種措施？
A 45-year-old client with Type 1 Diabetes Mellitus presents with Kussmaul respirations, fruity breath odor, and a blood glucose level of 480 mg/dL. Which nursing action is the priority?
- AAdminister potassium chloride給予氯化鉀
- BAdminister subcutaneous insulin給予皮下注射胰島素
- CInitiate an intravenous fluid bolus of 0.9% Normal Saline✓ 正解開始輸注 0.9% 生理鹽水靜脈推注
- DObtain a urine sample for ketones取得尿液樣本進行酮體檢測
此病人呈現典型的糖尿病酮酸中毒（DKA）。首要處置是使用 0.9% 生理食鹽水進行靜脈輸液復甦，以糾正脫水並改善組織灌流，這是所有治療的基礎。皮下胰島素吸收不穩定且無法快速降糖，DKA 需給予靜脈輸注胰島素。鉀離子在確認尿量足夠前不可給予。尿液檢查屬後續診斷，非緊急搶救。
This client presents with classic diabetic ketoacidosis (DKA). The priority intervention is fluid resuscitation with 0.9% normal saline IV to correct dehydration and improve tissue perfusion, which is the foundation of all subsequent therapy. Subcutaneous insulin is absorbed unreliably and cannot rapidly lower glucose; DKA requires an IV insulin infusion. Potassium should not be given until adequate urine output is confirmed. Urine testing is a subsequent diagnostic step and not an emergent intervention.
美國急診護理師依 DKA protocol 可先掛 NS 並執行醫囑，台灣通常需醫師到場確認後方可進行後續胰島素治療。