護理師教導病人如何預防草酸鈣腎結石。衛教內容應包含哪些？（選所有適合的）
A nurse is teaching a client about the prevention of calcium oxalate kidney stones. Which instructions should the nurse include? (Select all that apply.)
- AIncrease daily fluid intake to 2.5-3 liters✓ 正解每日液體攝取量增加至 2.5-3 公升
- BLimit intake of spinach, rhubarb, and beets✓ 正解限制菠菜、大黃與甜菜的攝取
- CSignificantly reduce dietary calcium intake大幅減少膳食鈣攝取
- DReduce sodium intake✓ 正解減少鈉攝取
- EAvoid excessive intake of animal protein✓ 正解避免過量攝取動物性蛋白質
預防草酸鈣結石的核心策略在於稀釋尿液並減少成石物質的濃度。1. 增加水分（A）是最重要的，能降低晶體飽和度。2. 限制高草酸食物（B）如菠菜、大黃，直接減少原料。3. 減少鈉（D）能減少尿鈣排出。4. 減少動物蛋白（E）可降低尿酸與尿鈣，增加尿液中的檸檬酸（結石抑制物）。陷阱在 C：過去認為要限鈣，但現代醫學發現「正常」鈣攝取反而能與腸道中的草酸結合並排出，防止其進入尿路。因此，過度限鈣反而會增加結石風險並導致骨質疏鬆。護理衛教應基於實證，協助病人調整長期飲食習慣以減少風險潛力。
Prevention of calcium oxalate stones centers on diluting urine and reducing stone-forming substances. 1) Increase fluids (A) to lower crystal saturation. 2) Limit high-oxalate foods (B) such as spinach and rhubarb. 3) Reduce sodium (D) to decrease urinary calcium excretion. 4) Limit animal protein (E) to lower urinary uric acid and calcium and raise citrate (a stone inhibitor). The trap is C: while older teaching restricted calcium, evidence shows normal calcium intake binds oxalate in the gut for excretion, preventing it from entering the urinary tract. Excess calcium restriction actually increases stone risk and risks osteoporosis. Teaching must be evidence-based to support sustainable dietary change.
美國飲食中鈉含量與動物蛋白普遍較高，護理師更強調閱讀食品標籤；台灣衛教則常提醒病人少喝含糖飲料（尤其是草酸含量高的濃茶）與增加日常飲水量。