— 基本照護與舒適 · EASY · MCQ —
護理師照顧一位長期臥床的病人，下列哪項行動是預防壓瘡發生的首要任務？
A nurse is caring for a client who is immobile. Which action is the priority to prevent the development of pressure ulcers?
- APlacing the client on a high-protein diet讓患者攝取高蛋白飲食
- BPerforming passive range of motion exercises執行被動關節活動範圍運動
- CRepositioning the client every 2 hours✓ 正解每 2 小時協助患者翻身
- DApplying a barrier cream to bony prominences在骨突處塗抹屏障霜
— Explanation · 中文詳解 —
長期臥床病人預防壓瘡（Pressure Ulcers）的黃金準則是「減壓」。每兩小時翻身（Repositioning）能有效避免身體部位持續承受壓迫，改善受壓區域的血液循環。這是預防壓瘡最基礎且最有效的措施。雖然營養支持、被動運動與使用皮膚保護劑也很重要，但翻身是直接解決「壓力」這一成因的最優先行動。護理師應確保翻身計畫落實並記錄。
For immobile clients, pressure relief is the cornerstone of pressure ulcer prevention. Repositioning at least every 2 hours removes sustained pressure from bony prominences and restores tissue perfusion. While nutrition, ROM exercises, and barrier creams support skin integrity, none directly addresses the causative factor—pressure—as effectively as scheduled repositioning.