一位病人左小腿診斷為深層靜脈栓塞（DVT）。下列何項護理措施對預防肺栓塞至關重要？
A client presents with deep vein thrombosis (DVT) in the left calf. Which nursing intervention is essential to prevent a pulmonary embolism?
- AAdminister anticoagulant therapy as prescribed依醫囑給予抗凝血治療正確答案
- BMassage the calf to improve circulation按摩小腿以促進循環
- CApply a heating pad to the calf在小腿處應用熱敷墊
- DPerform passive range of motion exercises執行被動關節活動範圍運動
- A依醫囑給予抗凝血治療
預防深部靜脈血栓（DVT）進展為肺栓塞（PE）的關鍵措施是依醫囑給予抗凝血治療（選項 A）：抗凝血劑可抑制血栓繼續延伸並讓內生纖溶系統逐步清除血栓，是唯一能實質降低栓子脫落與肺栓塞風險的介入。現行照護標準已不再要求絕對臥床——長時間臥床本身即為靜脈血栓栓塞症的危險因子，在有效抗凝之下應鼓勵病人早期下床活動，並未增加肺栓塞發生率。選項 B 按摩患肢屬絕對禁忌，外力可能使血栓脫落而直接誘發肺栓塞；C 於患肢熱敷無法改變血栓自然史，且可能加重局部腫脹與不適；D 被動關節運動不是預防肺栓塞的關鍵措施，且在抗凝尚未生效前對患肢施力活動也有使血栓移位的疑慮。臨床提醒：應同時衛教病人辨識肺栓塞警訊——突發性呼吸困難、胸痛（吸氣時加劇）、心搏過速或咳血，出現時須立即就醫。
- A · 正確答案依醫囑給予抗凝血治療
絕對臥床休息能減少患肢肌肉對靜脈的擠壓，降低血栓隨血液脫落進入肺循環的風險，是急性期最關鍵的預防措施。
- B按摩小腿以促進循環
按摩患肢會直接導致血栓剝離，物理性刺激是導致血栓脫落進入肺循環的最直接誘因，故絕對禁止。
- C在小腿處應用熱敷墊
熱敷會導致局部血管擴張，增加血流速度，若血栓不穩定，極易導致其脫落引發肺栓塞，為禁止行為。
- D執行被動關節活動範圍運動
被動關節活動會引起肌肉收縮，進而擠壓靜脈導致血栓脫落，急性期內應避免患肢過度活動。
台灣與美國對於 DVT 急性期的處理標準一致，均強調抗凝血治療與初期臥床。但在美國，一旦抗凝血劑（如 Heparin 或 LMWH）達到治療濃度，臨床醫師通常會儘早鼓勵病人下床活動，以降低併發症，而非長期臥床。
English explanation
Option A is correct because prescribed anticoagulant therapy inhibits further extension of the deep vein thrombosis and allows the endogenous fibrinolytic system to clear the clot gradually, materially reducing the risk that an embolus will dislodge and cause pulmonary embolism. Prolonged bed rest is itself a risk factor for venous thromboembolism, so early ambulation should be encouraged once anticoagulation is effective; this does not increase the incidence of pulmonary embolism. Option B is incorrect because massaging the affected calf is absolutely contraindicated and may dislodge the thrombus. Option C is incorrect because applying heat does not alter the natural history of the clot and may worsen local swelling and discomfort. Option D is incorrect because passive range-of-motion exercises do not prevent pulmonary embolism, and manipulating the affected limb before anticoagulation is effective may displace the thrombus. The client should seek immediate care for warning signs of pulmonary embolism, including sudden dyspnea, chest pain that worsens with inspiration, tachycardia, or hemoptysis.