— 降低風險 · MEDIUM · SATA —
護理師正在照顧一位有跌倒病史的病人。該病人被處方使用鎮靜劑。下列哪些介入措施最能有效預防跌倒？（選所有適合的）
A nurse is caring for a client with a history of falls. The client is prescribed a sedative. Which of the following interventions would be most effective in preventing falls? (Select all that apply.)
- AEnsure the client's environment is well-lit✓ 正解確保病人環境照明充足
- BEducate the client about the risks of dizziness and impaired coordination✓ 正解教育病人關於頭暈和協調能力受損的風險
- CKeep the bed in the lowest position with brakes locked✓ 正解將床置於最低位置並鎖定輪子
- DEncourage frequent toileting鼓勵頻繁如廁
- ERemove throw rugs and clutter from the room✓ 正解移除房間內的拋棄式地毯和雜物
— Explanation · 中文詳解 —
鎮靜劑會降低病人的警覺性、反應速度以及平衡感，顯著提高跌倒風險。針對此類病人，應採取綜合性的預防策略：確保環境照明充足以防絆倒、教育病人了解藥物副作用以便其採取防禦行為、降低床鋪高度並鎖定車輪、移除環境中所有可能絆倒人的雜物。這些措施共同構成了一個多層次的安全防護網，能有效降低因藥物影響導致的跌倒發生率。
Preventing falls in clients taking sedatives requires a multi-faceted approach including environmental safety and client education. Key interventions include ensuring adequate lighting, keeping the bed low with brakes locked, removing tripping hazards, and educating the client about dizziness risks.