護理師正準備為低血鉀病人靜脈輸注氯化鉀。開始輸注前最重要的護理措施為何？
A nurse is administering a dose of IV potassium chloride to a client with hypokalemia. What is the priority nursing action before starting the infusion?
- AAssess for a positive Trousseau's sign評估是否有陽性的 Trousseau 徵象
- BEnsure the IV site is in the antecubital fossa確保靜脈注射部位位於肘窩
- CVerify the presence of a patent urine output✓ 正解確認有暢通的尿液排出
- DCheck the client's blood pressure檢查病人的血壓
氯化鉀（Potassium Chloride, KCl）屬於高警訊藥物（High-Alert Medication）。鉀離子主要經由腎臟排泄，若病人無尿（Anuria）或腎功能嚴重受損，輸注鉀離子將導致血鉀迅速飆升，引發致命性心律不整（如心室顫動）。臨床上，給予鉀離子前，必須確認病人有排尿（通常建議至少 0.5 mL/kg/hr），以確保腎臟具備排鉀能力。這是給藥前的安全性評估重點，屬優先護理措施。
Potassium chloride is a high-alert medication. Potassium is excreted by the kidneys, so anuria or severe renal impairment will cause potassium to accumulate quickly, producing life-threatening hyperkalemia and fatal dysrhythmias. Verifying adequate urine output (typically at least 0.5 mL/kg/hr) confirms renal function and is the priority safety assessment before administering IV potassium.
美國臨床對於高濃度鉀離子給藥規範極嚴，通常要求必須透過中央靜脈導管（CVC）或輸液幫浦（Infusion Pump）給予，且護理師需嚴格執行雙人核對（Double-check）。