一位心因性厭食症病人因嚴重營養不良入院。在重新餵食治療（Refeeding therapy）的第一週，哪項護理處置最為關鍵？
A client with Anorexia Nervosa has been hospitalized for severe malnutrition. Which intervention is most critical during the first week of refeeding therapy?
- AAllow the client to choose their own meals from the hospital menu.允許病人從醫院菜單中自行選擇餐點。
- BEncourage the client to participate in group therapy sessions.鼓勵病人參與團體治療課程。
- CMonitor serum phosphorus, potassium, and magnesium levels.✓ 正解監測血清磷、鉀和鎂濃度。
- DSet a goal for a weight gain of 3 to 5 lbs per week.設定每週體重增加 3 至 5 磅的目標。
在厭食症治療的初期，最危險的併發症是「重新餵食症候群（Refeeding Syndrome）」。當長期飢餓的病人突然攝取碳水化合物時，胰島素分泌增加，促使電解質（特別是磷、鉀、鎂）從細胞外液大量移入細胞內，導致血清中的這些電解質濃度驟降，進而引發心律不整、呼吸衰竭甚至死亡。因此，監測電解質（選項 C）是生命安全的第一要務。選項 D 的體重增加目標過快，會增加心臟負荷，通常目標設定在每週 1-2 磅。選項 B 的心理治療固然重要，但在生理穩定後才進行。選項 A 對於有嚴重飲食控制障礙的病人不適用，初期通常由醫療團隊嚴格規範飲食。臨床思路上，生理安全（ABC 與電解質平衡）永遠優先於心理社會需求。
During the early phase of treating anorexia nervosa, the most dangerous complication is refeeding syndrome. When a chronically starved client suddenly ingests carbohydrates, insulin secretion rises and drives electrolytes (especially phosphorus, potassium, and magnesium) from the extracellular fluid into the cells, causing precipitous drops in serum levels that can trigger cardiac dysrhythmias, respiratory failure, and even death. Therefore, monitoring electrolytes (option C) is the top safety priority. The weight gain target in option D is too rapid and would strain the heart; the recommended goal is usually 1-2 lbs per week. Group therapy (option B) is important but should follow physiologic stabilization. Self-selected meals (option A) are inappropriate for clients with severe eating disorders, as initial intake is usually strictly directed by the treatment team. Clinically, physiologic safety (ABCs and electrolyte balance) always takes precedence over psychosocial needs.
美國護理標準對於 Refeeding Syndrome 的警覺性極高，護理師需具備判讀實驗室數值並立即回報的能力；台灣臨床上也遵循此原則，但在厭食症專科病房較少，多分散在一般內科或精神科，護理師需具備跨科別的警覺意識。