病人正接受靜脈注射萬古黴素,護理師發現滴速過快,且病人臉部、頸部及前胸出現潮紅。應優先採取何種處置?
A client is prescribed intravenous vancomycin. The nurse notes the infusion rate is too fast, and the client develops redness on the face, neck, and upper chest. What is the priority intervention?
- ANotify the physician通知醫師
- BAdminister an antihistamine給予抗組織胺
- CStop the infusion immediately✓ 正解立即停止輸注
- DContinue at a slower rate以較慢速率繼續輸注
紅人症候群(Red Man Syndrome)是由萬古黴素(vancomycin)輸注過快導致組胺大量釋放所引起的反應,表現為臉部、頸部及前胸潮紅。發生時,護理師應立即停止輸注,以中斷過敏原輸入。待症狀緩解後,通常需延長輸注時間(建議至少 60 分鐘以上)並依醫囑考慮給予抗組織胺。這是臨床護理中常見的藥物反應處置。
Red Man Syndrome is a histamine-release reaction caused by overly rapid infusion of vancomycin, producing flushing of the face, neck, and upper chest. When it occurs, the nurse must stop the infusion immediately to interrupt the trigger. After symptoms resolve, the infusion is typically restarted at a slower rate (at least 60 minutes), and antihistamines may be ordered. This is a common medication reaction managed in nursing practice.