護理師照護一名有吞嚥困難病史的病人。為了預防用餐時發生吸入性肺炎，應採取哪些措施？（選所有適合的）
A nurse is caring for a client with a history of dysphagia. Which interventions should the nurse implement to prevent aspiration during meals? (Select all that apply.)
- AAdd a thickening agent to thin liquids.在稀薄液體中添加增稠劑正確答案
- BPosition the client in a high-Fowler's position during meals.進餐時將病人置於高坐臥位正確答案
- CEncourage the client to use a straw for drinking.鼓勵病人使用吸管飲水
- DInstruct the client to tuck the chin when swallowing.指示病人在吞嚥時收下巴正確答案
- EProvide small, frequent bites of food.提供少量多次的食物正確答案
- A在稀薄液體中添加增稠劑
- B進餐時將病人置於高坐臥位
- D指示病人在吞嚥時收下巴
- E提供少量多次的食物
預防吞嚥困難病人吸入的核心在於控制食物流速與利用重力。增稠劑（A）可減慢液體在咽喉的流動速度，給予會厭軟骨更多反應時間來封閉氣道。高坐臥位（B）能利用重力防止食物逆流並優化吞嚥機制。縮下巴動作（D）可使會厭後移並縮小氣道開口，是預防嗆咳的關鍵技巧。小口餵食（E）可避免口腔內食物積聚過多導致失控。選項 C（使用吸管）是常見錯誤，吸管會使液體快速且難以控制地進入咽喉後部，顯著增加吸入風險。護理師應在餐後維持病人坐姿至少 30 分鐘，並持續檢查口腔是否有殘留食物（口袋化現象）。這類病人的安全管理需要多專業團隊協作，包括語言治療師的評估與營養師的質地調整。護理師的觀察力，如注意進食時的咳嗽、流淚或聲音改變（溼性嗓音），對於早期發現隱性吸入至關重要。
- A · 正確答案在稀薄液體中添加增稠劑
正確。液體增稠能降低流速，讓病人有充足時間啟動吞嚥反射，避免液體在氣道關閉前就掉入氣管，是吞嚥困難照護的基本準則。
- B · 正確答案進餐時將病人置於高坐臥位
正確。高坐臥位（90度）能確保食物在重力作用下順利下行，並減少胃食道逆流的可能，是進食時最安全的姿勢。
- C鼓勵病人使用吸管飲水
錯誤。吸管會加速液體流進咽部，病人往往來不及反應而造成吸入性嗆咳，應鼓勵直接用杯子小口啜飲或使用特製湯匙。
- D · 正確答案指示病人在吞嚥時收下巴
正確。縮下巴動作（Chin-tuck maneuver）能改變咽部解剖位置，使氣道開口變窄並保護聲帶，是臨床上非常有效的物理性保護機制。
- E · 正確答案提供少量多次的食物
正確。小口餵食可確保病人有足夠時間完成咀嚼與吞嚥動作，避免因口腔裝載過多食物而導致處理不及，降低嗆入風險。
美國醫院高度依賴語言治療師（SLP）進行 bedside swallow screen 與飲食分級（IDDSI標準）；台灣則多由護理師初步篩檢，再由復健科醫師或語言治療師介入。此外，美國較常使用商業化預拌增稠液，台灣則多由護理師或家屬在餐點中自行添加增稠粉。
English explanation
The core of preventing aspiration in patients with dysphagia is to control the rate of food flow and to use gravity. Thickening agents (A) slow the flow of liquids in the pharynx, giving the epiglottis more time to close off the airway. A high-Fowler's position (B) uses gravity to prevent reflux and optimize swallowing mechanics. The chin-tuck maneuver (D) moves the epiglottis backward and narrows the airway opening, making it a key technique for preventing aspiration. Small bites (E) prevent food from accumulating in the mouth and becoming uncontrolled. Option C (using a straw) is a common error, because a straw delivers liquid rapidly and uncontrollably to the back of the pharynx, significantly increasing the risk of aspiration. The nurse should keep the patient seated upright for at least 30 minutes after meals and continually check the mouth for retained food (pocketing). Care for these patients requires interdisciplinary collaboration, including evaluation by a speech therapist and texture modification by a dietitian. The nurse's observational skills, including watching for coughing, tearing, or voice changes (wet voice) during eating, are crucial for early identification of silent aspiration.
最近修訂：2026-10-06