一位病人術後兩小時，甲狀腺切除術後出現嘴唇與手指麻木感。護理師應採取哪項優先行動？
A nurse is assessing a client who is 2 hours post-thyroidectomy. The client exhibits tingling of the lips and fingers. Which action is the priority?
- ACheck the surgical dressing for bleeding檢查手術敷料是否有出血
- BElevate the head of the bed抬高床頭
- CAssess the client for Trousseau's sign評估病人是否有 Trousseau 徵象
- DAdminister IV calcium gluconate per standing orders✓ 正解依常規醫囑給予靜脈注射葡萄糖酸鈣
甲狀腺切除術後出現嘴唇手指麻木，暗示副甲狀腺受損導致急性低血鈣，可能引發喉頭痙攣危及生命。必須優先給予鈣離子靜脈注射以緊急糾正低血鈣。A是評估出血風險，C是確認診斷，B是減輕水腫，均非穩定氣道與生理平衡的即時搶救步驟。
Numbness of the lips and fingers following thyroidectomy suggests acute hypocalcemia due to parathyroid injury, which may trigger life-threatening laryngeal spasm. The priority is IV calcium administration to urgently correct the hypocalcemia. Option A addresses bleeding risk, option C confirms diagnosis, and option B reduces swelling, but none of these stabilize the airway or correct the underlying physiologic imbalance in the immediate setting.
美國護理師常有處理急性低血鈣的 protocol，台灣通常需聯繫醫師開立醫囑後才給藥。