— 心理社會完整性 · EASY · MCQ —
一位 45 歲患有廣泛性焦慮症的個案出現呼吸急促、心跳過速及強烈的瀕死感。護理師應採取的最優先行動為何？
A 45-year-old client with a history of generalized anxiety disorder presents with rapid breathing, tachycardia, and a feeling of impending doom. What is the nurse's priority action?
- AEncourage the client to discuss the source of their anxiety鼓勵病人討論其焦慮來源
- BAdminister the prescribed PRN anxiolytic medication immediately立即給予處方之 PRN 抗焦慮藥物
- CRemain with the client and maintain a calm, quiet environment✓ 正解陪伴病人並維持安靜平和的環境
- DInstruct the client to breathe into a paper bag指示病人使用紙袋呼吸
— Explanation · 中文詳解 —
面對焦慮發作（Panic attack），首要目標是降低刺激並提升個案的安全感。陪伴能給予心理支持，減少個案被孤立的恐懼。紙袋呼吸法已不建議使用，因可能導致缺氧；藥物需在評估後給予；討論焦慮源應等發作緩解後進行。
During a panic attack, the primary goal is to reduce stimulation and increase the client's sense of safety. Staying with the client provides emotional support and reduces fear of isolation. Paper bag rebreathing is no longer recommended because it may cause hypoxia; medication should be given only after assessment; and discussion of the underlying causes of anxiety should be reserved for after the acute episode subsides.
✦ 台美臨床差異
美國護理師常執行結構化的危機干預；台灣臨床對焦慮發作常傾向先給予安眠藥物。