— 生理適應 · MEDIUM · SATA —
護理師為病人穿戴彈性襪（TED hose），下列哪些介入是適當的？（選所有適合的）
Which nursing intervention is appropriate when applying an anti-embolism stocking (TED hose) to a client? (Select all that apply.)
- AMeasure the leg according to manufacturer guidelines✓ 正解依照製造商指引測量腿部
- BEnsure there are no wrinkles in the stocking✓ 正解確保襪子沒有皺褶
- CRemove the stockings once per shift to inspect the skin✓ 正解每班移除一次襪子以檢查皮膚狀況
- DEnsure the stocking is bunched at the ankle確保襪子在腳踝處堆積
- EApply the stockings after the client has been in bed all night✓ 正解在個案整夜卧床後再穿上襪子
— Explanation · 中文詳解 —
穿著彈性襪需正確測量長度以達適當壓力。襪子需平整（皺褶會造成止血帶效應）、每班移除以評估皮膚完整性。最好在清晨下床前穿戴，以防血液積聚。襪子絕對不能在腳踝處堆疊（Bunching），否則會阻斷局部循環。
Accurate measurement according to manufacturer guidelines ensures the stocking provides the correct graduated compression. The stocking must be applied smoothly without wrinkles to prevent uneven pressure and skin breakdown. It should be removed once per shift to allow for skin inspection and applied before the client gets out of bed to prevent venous pooling.
✦ 台美臨床差異
台美臨床對於彈性襪護理非常注重，差異不大，但美國護理資訊系統常有強制性的檢查勾選。