— 心理社會完整性 · EASY · MCQ —
一位 35 歲廣泛性焦慮症病史個案出現心悸、冒汗及瀕死感。護理師首要介入措施為何？
A 35-year-old client with a history of generalized anxiety disorder presents with reports of palpitations, sweating, and feelings of impending doom. Which intervention is the highest priority for the nurse?
- AAdminister the prescribed PRN anxiolytic medication給予處方中的按需（PRN）抗焦慮藥物
- BPerform a physical assessment to rule out cardiac pathology進行身體評估以排除心臟病理
- CInstruct the client to breathe deeply and slowly✓ 正解指示病人深呼吸並放慢速度
- DEncourage the client to discuss the cause of anxiety鼓勵病人討論焦慮的原因
— Explanation · 中文詳解 —
面對急性焦慮發作，優先穩定生理狀態是關鍵。透過深呼吸技術，能引導副交感神經運作，降低交感神經亢進引起的心搏過速與過度換氣。待症狀稍緩後，才適合進行藥物治療或心理探討，貿然深入討論可能導致病人焦慮加劇。
In an acute anxiety/panic episode, stabilizing the body comes first. Coaching slow, deep breathing activates the parasympathetic system and reduces sympathetic-driven tachycardia and hyperventilation. Once the client is more stable, PRN medication may be considered, and discussion of triggers can occur. Forcing the client to discuss the cause during the acute event can worsen anxiety.
✦ 台美臨床差異
美護理師依 protocol 採取非藥物介入；台護理師多等待醫師診斷排除心臟疾病後再介入。