— 安全與感染控制 · EASY · MCQ —
護理師為預防管灌病人發生吸入性肺炎，應採取何種行動？
Which action should the nurse take to prevent a client from aspirating during tube feeding?
- AAdminister feedings rapidly to save time快速給予灌食以節省時間
- BVerify tube placement using a syringe of air使用注射器注入空氣來確認管路位置
- CKeep the head of the bed elevated at least 30 degrees✓ 正解將床頭抬高至少 30 度
- DPlace the client in the supine position將病人置於仰臥姿勢
— Explanation · 中文詳解 —
管灌（Tube feeding）病人發生吸入性肺炎（Aspiration pneumonia）的主要風險在於胃內容物逆流至氣管。維持床頭抬高（Head of bed elevation）至少 30 度，能利用重力防止胃內容物逆流，這是預防吸入的最基本安全措施。此外，灌食前應確認管路位置，並控制灌食速度。
The main risk of aspiration pneumonia in tube-fed clients is reflux of gastric contents into the trachea. Maintaining the head of the bed elevated at least 30 degrees uses gravity to prevent reflux of gastric contents, which is the most basic safety measure for preventing aspiration. In addition, tube placement should be verified before feeding, and the feeding rate should be controlled.