護理師照顧一位使用 PCA（病人自控式止痛）的病人，需要執行哪些行動？（選所有適合的）

病人自控式止痛（Patient-Controlled Analgesia, PCA）是一種透過程式設定的輸液幫浦，讓病人在需要時能自行按鈕給予預設劑量的止痛藥，以達到最佳的疼痛控制。護理師在此過程中扮演著監控、評估與確保安全的重要角色。 正確選項 A、B、D、E 都是 PCA 照護的關鍵要求。A. 頻繁評估病人的疼痛程度，是判斷 PCA 藥物劑量與頻次是否足夠的基礎。B. 監測呼吸速率與鎮靜程度（sedation level）至關重要，因為過量的鴉片類藥物可能導致呼吸抑制。D. 依據機構政策定期檢查 PCA 幫浦的設定（如劑量、鎖定時間、基礎輸液速率），確保其運作正確。E. 強調病人是唯一能按壓止痛按鈕的人，是防止藥物濫用與過量給藥的關鍵安全措施。 錯誤選項 C（允許家屬按按鈕）是絕對禁止的行為。家屬的介入會打亂 PCA 的藥物動力學設定，可能導致病人過量給藥，引發嚴重的呼吸抑制甚至死亡。這也剝奪了病人對疼痛控制的自主權。 臨床思路：PCA 的安全性取決於嚴格的監測與病人教育。護理師需密切觀察病人的反應，並教育病人正確使用 PCA 的方法與重要性。安全優先：PCA 的最大風險是呼吸抑制，因此監測呼吸與鎮靜是重中之重；同時，確保只有病人本人操作，是預防過量給藥的基礎。

Patient-Controlled Analgesia (PCA) is a programmable infusion pump that allows the client to self-administer a preset dose of analgesic when needed in order to achieve optimal pain control. The nurse plays a critical role in monitoring, assessment, and safety throughout this process. The correct options A, B, D, and E are all key requirements of PCA care. A. Frequent assessment of the client's pain level is the basis for judging whether the PCA dosage and frequency are adequate. B. Monitoring respiratory rate and sedation level is essential, because excessive opioid administration can cause respiratory depression. D. Checking the PCA pump settings (dose, lockout interval, basal infusion rate) according to facility policy ensures correct operation. E. Emphasizing that only the client may press the medication button is a critical safety measure to prevent misuse and overdose. The incorrect option C (allowing family members to press the button) is strictly prohibited. Family activation disrupts the pharmacokinetic design of PCA, may lead to overdose, and can cause severe respiratory depression or death. It also undermines the client's autonomy over pain control. Clinical reasoning: PCA safety depends on strict monitoring and patient education. The nurse must observe the client's response closely and teach the client the correct use and importance of PCA. Safety first: the greatest risk of PCA is respiratory depression, so monitoring respiration and sedation is paramount; ensuring that only the client operates the device is the foundation for preventing overdose.

PCA (Patient-Controlled Analgesia) 的使用與照護原則在台美兩地是相同的，均強調病人自主控制、嚴格監測呼吸與鎮靜，以及禁止家屬代為操作。美國在推廣 PCA 的同時，也發展出更精確的幫浦設定與監測系統。台灣的醫院也廣泛使用 PCA，但對家屬代按的禁忌強調程度可能因醫院文化而異，但核心安全原則一致。