護理師評估一位甲狀腺切除術後 6 小時的病人。病人主訴手指尖和嘴唇周圍有刺痛感。護理師應優先查看哪項實驗室檢查結果？
A nurse is assessing a client who is 6 hours post-operative following a thyroidectomy. The client reports a tingling sensation in the fingertips and around the mouth. Which laboratory result should the nurse review first?
- AHemoglobin and hematocrit血紅素與血比容
- BSerum sodium level血清鈉濃度
- CSerum calcium level✓ 正解血清鈣濃度
- DSerum potassium level血清鉀濃度
甲狀腺切除術後最常見且具風險的併發症之一是意外損傷副甲狀腺，導致副甲狀腺素分泌不足。這會進一步引起血鈣迅速下降（低血鈣）。病人的臨床表現（手指尖與口周刺痛）是低血鈣引發的神經肌肉興奮性增高的典型早期徵兆（Paresthesia）。若不處理，可能進展為 Trousseau's sign 或 Chvostek's sign，甚至發生喉頭痙攣危及生命。因此，護理師的首要行動是確認血鈣數值。雖然術後監測血紅素（出血風險）也很重要，但針對「刺痛感」這一特異性主訴，血鈣才是最具直接關聯的指標。臨床上，護理師應具備從症狀聯想到潛在電解質失衡的能力，並在發生抽搐前啟動醫療介入。
One of the most common and significant complications after thyroidectomy is inadvertent injury to the parathyroid glands, leading to insufficient parathyroid hormone secretion. This in turn causes a rapid decline in serum calcium (hypocalcemia). The patient's clinical presentation (tingling of the fingertips and around the mouth) is a classic early sign of hypocalcemia-induced increased neuromuscular excitability (paresthesia). If untreated, it may progress to Trousseau's sign or Chvostek's sign and even laryngospasm, which can be life-threatening. Therefore, the nurse's priority action is to verify the serum calcium level. Although postoperative monitoring of hemoglobin (for bleeding risk) is also important, for the specific complaint of "tingling," serum calcium is the most directly relevant indicator. Clinically, the nurse must be able to associate symptoms with underlying electrolyte imbalances and initiate medical intervention before the onset of tetany.
在美國，術後血鈣監測通常有標準化的 Standing Orders（預設醫囑），護理師若發現異常可立即依協議給予葡萄糖酸鈣；台灣則需先取得檢驗報告後，由護理師通知醫師，再由醫師開立補鈣醫囑。