護理師照護一位急性胰臟炎病人。下列哪些臨床表現顯示病人正在發展全身性併發症？（選所有適合的）
A nurse is caring for a client with acute pancreatitis. Which of the following clinical findings would indicate that the client is developing a systemic complication? (Select all that apply.)
- ABlood pressure 88/50 mmHg✓ 正解血壓 88/50 mmHg
- BSerum calcium 7.2 mg/dL (1.8 mmol/L)✓ 正解血清鈣 7.2 mg/dL (1.8 mmol/L)
- CLeft-sided crackles and diminished breath sounds✓ 正解左側濕囉音及呼吸音減弱
- DCullen's sign present in the periumbilical area✓ 正解臍周圍出現Cullen氏徵
- EBowel sounds are hyperactive in all four quadrants四個象限腸音均過度活躍
急性胰臟炎的併發症可波及全身各系統。低血壓（A）代表可能發生了低血容性休克，係因血管通透性增加導致大量液體移入第三空間。低血鈣（B）是嚴重程度的指標，主因是脂肪壞死與鈣離子結合（皂化反應），會增加神經肌肉興奮性甚至心律不整。呼吸系統併發症（C）如肋膜積水或 ARDS 非常常見，因為發炎酵素會損害肺泡毛細血管。Cullen's sign（D）臍周瘀斑代表出血性胰臟炎，預後較差。而腸音通常是減弱或消失（麻痺性腸阻塞），而非過度活躍（E）。臨床思維應放在監測休克、電解質失衡與多器官衰竭（MODS）的早期徵兆上。
Complications of acute pancreatitis can affect every body system. Hypotension (A) may indicate hypovolemic shock due to increased vascular permeability and massive fluid shifts into the third space. Hypocalcemia (B) is an indicator of severity, mainly caused by fat necrosis binding with calcium ions (saponification), which increases neuromuscular excitability and may even lead to arrhythmias. Respiratory complications (C), such as pleural effusion or ARDS, are common because inflammatory enzymes damage the alveolar-capillary membrane. Cullen's sign (D), periumbilical ecchymosis, indicates hemorrhagic pancreatitis and a worse prognosis. Bowel sounds are usually hypoactive or absent (paralytic ileus) rather than hyperactive (E). Clinical thinking should focus on monitoring for shock, electrolyte imbalance, and early signs of multiple organ dysfunction syndrome (MODS).
在美國護理實務中，護理師對於低血鈣引發的 Trousseau's 或 Chvostek's sign 的評估非常強調，且對胰臟炎引發 ARDS 的警覺性極高。台灣臨床則較常依賴抽血數值（Amylase/Lipase）與影像學判斷，但對身體評估徵象（如 Cullen's sign）的即時回報在兩地皆為標準要求。