一名 25 歲患有廣泛性焦慮症的病人前來門診，主訴心悸、呼吸困難及瀕死感。護理師應採取的優先護理措施為何？
A 25-year-old client with a history of generalized anxiety disorder presents to the clinic with reports of heart palpitations, shortness of breath, and a fear of dying. What is the priority nursing intervention?
- APerform a comprehensive physical assessment進行全面的生理評估
- BEncourage the client to ventilate feelings鼓勵個案表達感受
- CAdminister an ordered PRN dose of anxiolytic給予處方備用劑量的抗焦慮藥
- DInstruct the client to breathe slowly with the nurse✓ 正解指導個案與護理師一同緩慢呼吸
面對急性焦慮發作（恐慌發作），優先事項是協助病人穩定生理反應。透過引導式呼吸（Pursed-lip breathing 或緩慢呼吸）能激活副交感神經，對抗交感神經過度興奮引起的過度換氣與心悸。其他選項如給予藥物或深度諮商皆需在病人情緒穩定後進行，優先穩定呼吸以減緩生理不適最為關鍵。
The priority intervention is to instruct the client to breathe slowly with the nurse to help manage hyperventilation and activate the parasympathetic nervous system. This immediate physiological stabilization addresses the acute symptoms of palpitations and shortness of breath before other assessments or discussions. While assessment and medication are important, guiding breathing provides rapid relief and reduces the client's heightened arousal.
台美護理師皆需優先處理焦慮發作之呼吸緩解，台灣臨床常由醫師先排除器質性疾病後才交由護理師進行穩定處置。