護理師正在為一位未受過割禮(包皮未環切)的男性病人進行會陰護理。下列哪項行為是適當的?
The nurse is providing perineal care for an uncircumcised male client. Which action is appropriate?
- AUsing vigorous scrubbing to remove smegma under the foreskin.用力擦洗以清除包皮下的包皮垢
- BWashing the tip of the penis using a circular motion from the meatus outward.✓ 正解以由尿道口向外畫圓的方式清洗龜頭尖端
- CRetracting the foreskin and leaving it retracted to dry.將包皮退縮並保持退縮狀態以利乾燥
- DAvoiding retraction of the foreskin to prevent tissue trauma.避免退縮包皮以防止組織創傷
男性會陰護理的核心在於感染預防與組織保護。正確步驟是將包皮輕輕往下拉(Retract),清潔內部的包皮垢(Smegma),並以尿道口為中心向外環形擦拭,這是為了避免將尿道口周圍的細菌帶入尿道(由內向外、由乾淨到髒的原則)。最關鍵的後續動作是:清潔完畢後必須將包皮『復位』(Return to natural position)。如果包皮維持在退縮狀態,會導致局部循環受阻、水腫,甚至發生嵌頓性包莖(Paraphimosis),這是一項醫療緊急狀況。此題測驗基礎衛生的標準操作程序。不退縮包皮(D)會導致細菌滋生,過力洗刷(A)則會損傷脆弱粘膜。
Perineal care for an uncircumcised male requires gently retracting the foreskin to clean accumulated smegma, then cleansing the glans from the meatus outward in a circular motion (from cleanest to less clean, preventing pathogen migration into the urethra). The foreskin must be returned to its natural position afterward to prevent paraphimosis (a medical emergency). Vigorous scrubbing damages delicate mucosa.
在美國,這類基礎生活照護常由護理助理(CNA)執行,但護理師(RN)必須負責監督與評估組織完整性;在台灣,此類工作多由護理師或家屬執行,對於『復位』包皮的專業衛教在臨床交班中常被忽略。