對於一位 BMI 為 14 的厭食症病人,優先的護理干預為何?
Which nursing intervention is a priority for a client with anorexia nervosa who has a BMI of 14?
- AHelping the client choose a high-calorie menu.協助病人選擇高熱量菜單
- BIdentifying the client's body image distortion.辨識病人的身體形象扭曲
- CEngaging the client in group therapy.讓病人參與團體治療
- DMonitoring for electrolyte imbalances and cardiac arrhythmias.✓ 正解監測電解質失衡與心律不整
對於厭食症(Anorexia Nervosa)病人,若身體質量指數(BMI)僅為 14,這表示其處於嚴重營養不良狀態,生命徵象和生理功能可能極不穩定。在此情況下,護理師的優先干預措施必須是處理最危及生命的生理併發症。嚴重營養不良會導致電解質不平衡、心律不整、低血壓和體溫過低等,這些都可能迅速惡化並導致死亡。因此,在任何心理治療或營養復原計畫之前,必須確保病人的生理穩定。
For a client with anorexia nervosa and a BMI of 14, severe malnutrition poses an immediate risk of life-threatening complications such as electrolyte imbalances and cardiac arrhythmias. Therefore, monitoring for these physiological instabilities is the nursing priority over psychological interventions or gradual nutritional planning, which must be managed carefully to avoid refeeding syndrome.
厭食症的照護原則,尤其是在嚴重營養不良情況下優先處理生理穩定,是全球醫療界的共識。關於再餵食症候群的監測和處理,包括電解質(磷、鉀、鎂)的密切監測和逐步增加熱量攝取,在美國和台灣都是標準的臨床實踐。兩地在多專科團隊合作(醫師、護理師、營養師、心理師)方面也高度相似。