外科單位同時收治四位病人。哪位病人應安排在最靠近護理站的病房?
A surgical unit is admitting four clients simultaneously. Which client should be assigned to the room closest to the nurses' station?
- AA stable client 4 days post-laparoscopic cholecystectomy reporting brief right shoulder pain腹腔鏡膽囊切除術後第 4 天、主訴短暫右肩痛的穩定個案
- BA client with bacterial meningitis requiring droplet precautions患有細菌性腦膜炎且需實施飛沫隔離的個案
- CA client with chronic back pain requiring frequent IV morphine for pain control需頻繁靜脈注射嗎啡以控制疼痛的慢性背痛個案
- DA confused older adult with advanced dementia who repeatedly attempts to climb out of bed✓ 正解患有晚期失智症且意識混亂、反覆試圖翻越床欄的年長個案
病房分配(Room assignment)的核心原則是依據安全風險而非診斷本身。最靠近護理站的房間應保留給有立即性安全威脅的病人,例如生理狀態極不穩定者,或具高跌倒/自我傷害風險而需密切視覺監測者。 選項 D 的失智老人正積極嘗試爬出床欄,屬於高跌倒風險(High fall risk),需要持續的視覺監測,以便護理師能即時介入避免跌倒造成傷害。將其安排在護理站視線範圍內,符合預防性安全管理原則。 選項 B 的細菌性腦膜炎雖須飛沫隔離(Droplet precautions),但隔離考量的是「單人房」與「PPE」,病房位置並非決定因素。選項 A 的腹腔鏡術後肩痛為預期的轉移性疼痛(referred pain),屬於穩定狀態。選項 C 的疼痛管理需要規律給藥,但無立即性安全風險。
Room assignments should prioritize patient safety risks over diagnostic labels. The confused older adult with dementia poses an immediate high fall risk by attempting to climb out of bed, necessitating placement in a room near the nurses' station for continuous visual monitoring and rapid intervention.
「到底誰要住護理站門口？」這在台美護理學管理是經典考題。答案除了是剛開完大刀隨時休克的病人外，就是「極度譫妄、會拔管、會跳床的危險老翁」。