— 生理適應 · MEDIUM · MCQ —
一位肝硬化病史的病人出現哪項評估發現需立即通知醫師？
Which assessment finding in a client with a history of cirrhosis warrants immediate notification of the provider?
- AConfusion and lethargy✓ 正解意識混亂和嗜睡
- BAsterixis (hand flapping tremor)震顫（手部拍打樣震顫）
- CJaundice of the sclera鞏膜黃疸
- DSpider angiomas on the chest胸部蜘蛛狀血管瘤
— Explanation · 中文詳解 —
肝硬化病患出現混亂與嗜睡（意識狀態改變），極可能是肝性腦病變（Hepatic Encephalopathy）的表現，暗示血氨指數升高。這是危險併發症，可能導致昏迷，必須優先處理與回報，而其他選項如震顫、黃疸為肝硬化慢性病程常見症狀。
Confusion and lethargy indicate altered mental status, which is a priority sign of severe hepatic encephalopathy caused by elevated ammonia levels. This condition can rapidly progress to coma and requires immediate medical intervention, whereas asterixis, jaundice, and spider angiomas are expected or chronic manifestations of cirrhosis.
✦ 台美臨床差異
兩地對肝性腦病變的警覺性皆高，美國護理師常有權直接執行 lactulose 給藥 Protocol，台灣則多需先確認醫囑。