腫瘤科護理師照顧化療併發症病人。下列哪項急性臨床發現需要護理師最優先處置以防致命結果？
An oncology nurse cares for a client experiencing complications from chemotherapy. Which acute clinical finding requires the nurse's immediate intervention to prevent a potentially fatal outcome?
- ANeutropenia with new erythema at the central port-a-cath site and temperature of 38.3°C.✓ 正解中性球低下伴隨中央Port-A-Cath導管部位出現新發紅斑且體溫為38.3°C。
- BSevere oral mucositis with burning pain affecting nutrition.嚴重的口腔黏膜炎伴隨影響營養攝取的灼痛感。
- CScattered petechiae on the upper extremities indicating thrombocytopenia.上肢散在瘀點提示血小板低下。
- DNausea and vomiting of 200 mL of bilious gastric content.嘔吐出200毫升膽汁性胃內容物。
中性球低下發燒（Febrile Neutropenia, FN）合併中央靜脈導管（port-a-cath）感染徵象 = 腫瘤科真正的急症（oncologic emergency）。 選項 A 正確：中性球低下時，發燒 38.3°C + 導管周邊發紅，強烈暗示菌血症（bacteremia）/敗血症即將發生。每延遲 1 小時抗生素投予，死亡率上升。必須立即抽血培養（含導管與周邊）並在 1 小時內給予 IV 廣效抗生素。 選項 B：黏膜炎需止痛與口腔護理但非數小時內致命。 選項 D：嘔吐需止吐與電解質追蹤但非優先。 選項 C：血小板低下需監測出血但無立即敗血。
Febrile neutropenia (FN) with central line infection signs is a true oncologic emergency. A is correct: Neutropenia + fever 38.3°C + erythema at the port-a-cath site strongly suggests impending bacteremia/sepsis. Each hour of antibiotic delay increases mortality. Immediate blood cultures (line and peripheral) and IV broad-spectrum antibiotics within 1 hour are required. A: Mucositis needs pain control and oral care but not lethal in hours. B: Vomiting needs antiemetics and electrolyte monitoring—not first priority. D: Thrombocytopenia needs bleeding precautions but no immediate sepsis.
只要看到發燒 + 免疫低下(ANC=0) + 人工血管，就是敗血症死神。