— 健康促進與維護 · HARD · SATA —
護理師教導個案使用誘發性肺量計 (Incentive Spirometer)。個案出現哪些行為代表學習有效?(選所有適合的)
A nurse is educating a client about the use of an incentive spirometer. Which actions by the client indicate effective learning? (Select all that apply.)
- AExhale forcefully into the device向裝置用力呼氣
- BMaintain a slow, deep inhalation✓ 正解維持緩慢且深沉的吸氣
- CHold the breath for 3 to 5 seconds at maximal inspiration✓ 正解在最大吸氣時憋氣 3 至 5 秒
- DPerform the maneuver 10 times every hour while awake✓ 正解清醒時每小時進行 10 次操作
- EUse the device only when feeling short of breath仅在感到呼吸困難時使用該裝置
— Explanation · 中文詳解 —
誘發性肺量計使用原則為「吸氣」(非呼氣),應深且慢地吸入以擴張肺泡。呼氣用力(A)錯誤;憋氣 3-5 秒(C)有助於氣體分佈於肺底;頻率需維持每小時 10 次以防肺塌陷(D)。並非有症狀才用,預防性使用才是重點(E)。
Effective use involves taking a slow, deep breath to maximize lung expansion, holding it for 3 to 5 seconds to facilitate alveolar inflation, and repeating the process hourly while awake to prevent atelectasis. Forceful exhalation or using the device only when symptomatic does not achieve these preventive goals.
✦ 台美臨床差異
美國術後護理常由呼吸治療師 (RT) 共同參與指導;台灣通常由護理師獨力完成此衛教。