— 生理適應 · MEDIUM · MCQ —
一位急性胰臟炎病人主訴上腹部劇痛並放射至背部。護理師最合適的處置為何？
A client with acute pancreatitis reports severe epigastric pain radiating to the back. Which nursing intervention is most appropriate?
- AAdminister morphine sulfate as ordered依醫囑給予硫酸嗎啡
- BEncourage clear liquids to keep the patient hydrated鼓勵攝取清流質以維持病人水分
- CAssist the patient in a prone position to reduce pain協助病人採取俯臥姿勢以減輕疼痛
- DMaintain the client NPO and manage pain✓ 正解維持病人禁食並處理疼痛
— Explanation · 中文詳解 —
急性胰臟炎治療核心為「胰臟休息」，因此須禁食（NPO）以減少胰液分泌。疼痛控制是護理重點，且應避免使用嗎啡（過去認為會導致 Oddi 括約肌收縮，雖有爭議，但臨床考題中傾向選其他選項或給予其他止痛藥）。姿勢上建議採彎曲膝蓋的側臥位而非俯臥位。
The core of acute pancreatitis treatment is "pancreatic rest," so the client must be kept NPO to reduce pancreatic secretions. Pain control is a nursing priority, and morphine should be avoided (it was previously believed to cause sphincter of Oddi spasm, and although this is debated, the clinical examination still favors other options or alternative analgesics). Position should be side-lying with the knees flexed rather than prone.
✦ 台美臨床差異
美國臨床更傾向於使用 PCA 或其他鴉片類藥物，台灣臨床較常見先給予點滴補充並嚴格禁食，止痛藥使用較為謹慎。