一位肝硬化病人表現出意識混亂與嗜睡。護理師應優先關注哪項實驗室數據？
A client with a diagnosis of cirrhosis is presenting with confusion and lethargy. Which laboratory finding should the nurse prioritize?
- ASerum ammonia✓ 正解血清氨
- BPlatelet count血小板計數
- CProthrombin time凝血酶原時間
- DSerum albumin血清白蛋白
肝硬化病人意識狀態改變，通常是肝腦病變（Hepatic Encephalopathy）的徵兆，主要由體內氨（Ammonia）濃度累積所致。氨會穿過血腦屏障引起中樞神經毒性。其他選項與凝血功能或營養狀態有關，但在急性意識改變時，代謝性腦病變是最危急的鑑別點。
Altered mental status in a client with cirrhosis is typically a sign of hepatic encephalopathy, which is caused mainly by the accumulation of ammonia in the body. Ammonia crosses the blood-brain barrier and causes central nervous system toxicity. The other options are related to coagulation function or nutritional status, but in the setting of acute mental status changes, metabolic encephalopathy is the most critical differential to consider.
美台皆會給予 Lactulose 治療，但美國護理師對判斷 Ammonia 與 Lactulose 滴定劑量有更高的專業權限與流程自主權。