一位患有廣泛性焦慮症的 45 歲病人出現呼吸急促、心搏過速及面臨死亡的恐懼感。護理師應優先採取哪項介入措施？
A 45-year-old client with a history of generalized anxiety disorder presents with rapid breathing, tachycardia, and a sense of impending doom. Which intervention is the most appropriate for the nurse to prioritize initially?
- ARemain with the client and use a calm, firm, low-pitched voice✓ 正解留在個案身邊，並使用平靜、堅定、低沉的聲音說話
- BAdminister an as-needed anxiolytic medication immediately立即給予按需使用的抗焦慮藥物
- CInstruct the client to breathe into a paper bag指導個案向紙袋內呼吸
- DEncourage the client to discuss the source of their anxiety鼓勵個案討論其焦慮的來源
面對急性焦慮發作，護理師的首要任務是提供「安全感（Safety）」與「穩定感（Stability）」。護理師應保持持續陪伴，運用冷靜、低沉且堅定的語調與病人溝通，以降低病人的恐慌感。紙袋呼吸法（breathing into a paper bag）現已被多數臨床指引建議棄用，因其可能導致二氧化碳堆積過度引發缺氧危險。藥物給予非首選，應先嘗試非藥物介入。
When facing an acute anxiety attack, the nurse's primary task is to provide a sense of safety and stability. The nurse should remain continuously with the client, communicating in a calm, low-pitched, and firm tone to reduce the client's feelings of panic. Breathing into a paper bag has been largely abandoned in current clinical guidelines, as it may cause excessive accumulation of carbon dioxide and lead to hypoxia. Medication is not the first-line intervention; nonpharmacological measures should be attempted first.