— 生理適應 · HARD · MCQ —
一位病人診斷為抗利尿激素分泌異常症候群（SIADH）。下列哪項護理評估結果最令人擔憂？
A client is diagnosed with SIADH. Which nursing assessment finding would be most concerning?
- ASerum sodium level of 118 mEq/L✓ 正解血清鈉濃度為 118 mEq/L
- BBlood pressure of 145/90 mmHg血壓為 145/90 mmHg
- CUrine specific gravity of 1.030尿液比重大 1.030
- DPresence of peripheral edema存在周邊水腫
— Explanation · 中文詳解 —
SIADH 會導致水分滯留與稀釋性低血鈉。血鈉濃度降至 118 mEq/L 屬於嚴重低血鈉，極易誘發腦水腫、癲癇發作甚至昏迷。相比於尿比重升高或輕微血壓異常，神經學症狀的惡化與危急程度極高的電解質失衡是必須優先處理的生命危險。
SIADH causes water retention and dilutional hyponatremia. A serum sodium level dropping to 118 mEq/L represents severe hyponatremia and may precipitate cerebral edema, seizures, or even coma. Compared with elevated urine specific gravity or mildly abnormal blood pressure, deterioration in neurological status and severe electrolyte imbalance represent the highest priority life-threatening problem.
✦ 台美臨床差異
美國 ICU 護理師可能需協助計算限制水分攝取量，台灣護理師亦同，但針對神經評估的頻率要求較嚴格。