— 生理適應 · HARD · MCQ —
慢性阻塞性肺病（COPD）病人發生呼吸性酸中毒，護理師應優先採取的措施是？
A client with chronic obstructive pulmonary disease (COPD) has developed respiratory acidosis. Which intervention is the priority?
- AIncrease the oxygen flow rate to 6 L/min將氧氣流量增加至 6 L/min
- BAdminister a sedative to decrease respiratory effort給予鎮靜劑以降低呼吸努力
- CAdminister sodium bicarbonate給予碳酸氫鈉
- DEncourage deep breathing and coughing✓ 正解鼓勵深呼吸和咳嗽
— Explanation · 中文詳解 —
呼吸性酸中毒的核心問題是 CO2 排出受阻。對於 COPD 病人，改善換氣（Ventilation）是首要目標。鼓勵深呼吸與咳嗽可協助清除氣道分泌物，擴張肺部以促進氣體交換。給予碳酸氫鈉無法解決換氣不足問題；增加氧氣流量會抑制缺氧驅動；鎮靜劑則會進一步抑制呼吸中樞，皆為不當處置。
Respiratory acidosis in COPD results from CO2 retention due to inadequate ventilation, making improved gas exchange the priority. Encouraging deep breathing and coughing helps clear secretions and expand the lungs, whereas high-flow oxygen may suppress the hypoxic drive and sedatives further depress respiration.
✦ 台美臨床差異
美國臨床護理師常協助執行鼓勵性呼吸訓練（Incentive Spirometry），台灣臨床亦推行，但在呼吸治療師介入時機點上有細微差異。