— 生理適應 · HARD · MCQ —
一位第一型糖尿病患被發現意識不清，血糖 35 mg/dL。護理師應採取何項行動？
A client with type 1 diabetes mellitus is found unconscious. Blood glucose is 35 mg/dL. Which action is appropriate?
- AObtain a venous blood sample for HbA1c取得靜脈血液樣本檢測糖化血色素
- BInitiate sliding scale insulin coverage啟動胰島素滑動劑量覆蓋方案
- CAdminister orange juice orally經口給予柳橙汁
- DAdminister 50% dextrose IV push✓ 正解靜脈推注給予 50% 葡萄糖
— Explanation · 中文詳解 —
意識不清的病人有窒息風險，嚴禁口服給糖。應立即建立靜脈管道給予高濃度葡萄糖液（D50W）。胰島素會使血糖更低，絕對禁用。HbA1c 為長效指標，此時非首要任務。快速提升血糖濃度以挽救神經功能受損是唯一目標。
An unconscious client is at risk for aspiration, so oral glucose administration is strictly contraindicated. IV access must be established immediately to administer a high-concentration glucose solution (D50W). Insulin would further lower blood glucose and is absolutely contraindicated. HbA1c is a long-term indicator and is not a priority at this moment. The only goal is to rapidly raise blood glucose to prevent neurologic injury.
✦ 台美臨床差異
美國醫院常見護理師依據緊急代碼直接執行 IV 給藥，台灣通常需確認醫囑，但低血糖昏迷通常視為緊急狀況可採取處置。