— 降低風險 · HARD · MCQ —
一位病人正在接受全靜脈營養（TPN）。哪項發現是護理師需優先處理的？
A client is receiving total parenteral nutrition (TPN). Which finding is a priority for the nurse to address?
- APresence of slight thirst出現輕微口渴
- BElevated blood glucose levels✓ 正解血糖升高
- CIncreased urine output尿量增加
- DWeight gain of 1 lb in 24 hours24小時內體重增加1磅
— Explanation · 中文詳解 —
TPN 溶液含有極高濃度的糖分，極易導致高血糖（hyperglycemia）。高血糖會引起滲透性利尿與電解質失衡，甚至昏迷，因此嚴密監測血糖並調整輸注速度是護理首要任務。體重微增、口渴與輕微尿量增加均屬預期內的正常反應。
Total parenteral nutrition (TPN) contains high concentrations of glucose, making elevated blood glucose levels a priority concern due to the risk of hyperosmolar complications and electrolyte imbalances. While mild thirst and weight gain are expected responses to fluid and nutritional intake, strict monitoring of blood glucose is essential to manage the metabolic load of TPN.
✦ 台美臨床差異
美台對 TPN 病人皆實施嚴格的血糖控制 protocol，護理師需定時執行 Fingerstick 血糖監測。