— 基本照護與舒適 · HARD · MCQ —
護理師為意識不清的病人進行會陰部護理。下列哪項是最重要的執行原則？
A nurse is performing perineal care for an unconscious client. What is the most important principle for the nurse to follow?
- AUse only cold water to reduce inflammation僅使用冷水以減輕發炎
- BApply heavy talcum powder to keep the area dry大量滑石粉以保持區域乾燥
- CClean the anal area before the genital area先清潔肛門區域再清潔生殖器區域
- DClean from the cleanest area to the dirtiest area✓ 正解由最清潔區域向最髒污區域清潔
— Explanation · 中文詳解 —
預防感染是會陰部護理的核心原則。遵循「由乾淨到髒」的順序（由尿道口向肛門，或由陰阜向會陰後方清潔）可防止糞便細菌帶入尿道造成泌尿道感染。冷水會導致肌肉緊張，嬰兒爽身粉容易結塊且可能被吸入肺部，皆非正確手法。
Infection prevention is the central principle of perineal care. Following the clean-to-dirty sequence (from the urethral opening toward the anus, or from the mons pubis toward the posterior perineum) prevents bacteria from the stool from being introduced into the urethra and causing a urinary tract infection. Cold water causes muscle tension, and infant talcum powder tends to clump and may be inhaled into the lungs, so neither is a correct technique.
✦ 台美臨床差異
台美在感染控制原則一致，執行細節上，美國更強調保護病人的隱私與尊嚴。