一位患有重症肌無力的78歲女性患有嚴重的口咽吞嚥困難。最近的吞嚥攝影確認了其具備因快速流動液體導致吸入氣管的高風險。醫療提供者開立了嚴格量身打造的飲食醫囑：「所有液體必須改變質地為花蜜般濃稠 (Nectar-thick)。」當護理師在審視膳食科送來的午餐餐盤時，必須立刻移除並禁止個案食用哪些品項？
A 78-year-old female with Myasthenia Gravis has severe oropharyngeal dysphagia. A recent swallow study confirmed a high risk of aspiration with fast-moving fluids. The healthcare provider orders a strictly tailored diet specifying, "All fluids must be modified to nectar-thick consistency." When reviewing the lunch tray provided by dietary services, which items must the nurse immediately remove and prohibit the client from consuming?
- AA dense nutritional protein shake pre-formulated to a honey-thick level.預先調配至蜂蜜狀濃稠度的高密度營養蛋白奶昔
- BA cold glass of regular iced water, clear chicken broth, and a cup of melting strawberry ice cream.✓ 正解一杯冷開水、清澈雞湯及一杯融化的草莓冰淇淋
- CA cup of artificially thickened apple juice and a serving of pureed mashed potatoes.一杯經人工增稠的蘋果汁及一份泥狀馬鈴薯泥
- DA thick serving of oatmeal prepared with dense cream and pureed steamed vegetables.以濃厚奶油製備的一份濃稠燕麥粥及泥狀蒸蔬菜
本題測驗基礎營養學對於吞嚥困難（Dysphagia）的液體質地改變。對於神經肌肉疾病（如重症肌無力、中風）導致會厭軟骨閉合遲緩的病患，「稀薄流質（Thin liquids 如水、茶、清湯）」是最致命的殺手。因為它們流動速度過快，會在氣管「門」關起來前直接漏進肺裡，引發吸入性肺炎。使用粉末將液體增稠（Thickened liquids，分為 Nectar花蜜狀、Honey蜂蜜狀、Pudding布丁狀）能減緩流速，讓肌肉有時間反應。選項B的配置：一般的冰塊開水（Iced water）與清雞湯（Clear chicken broth）皆為致命的稀薄危險物質；更棘手的是，冰冷呈固體的冰淇淋（Ice cream）或果凍在進入體溫口腔後，會瞬間融化成最危險的『水（Thin liquid）』。這整份（B）選項的餐點無疑是一份會導致病患溺水的毒藥餐，護理師必須立刻將其沒收並移除。選項C（已增稠的蘋果汁與馬鈴薯泥）、選項A（甚至更稠的蜜態奶昔）以及選項D（濃稠燕麥粥與蔬菜泥）皆為質地濃重、緩慢掉入胃裡的優秀吞嚥困難防護餐。
The client requires nectar-thick fluids to prevent aspiration due to delayed epiglottic closure. Option B contains thin liquids like water and broth, which flow too quickly, and ice cream, which melts into a dangerous thin liquid at body temperature, posing a high aspiration risk. Options A, C, and D consist of appropriately thickened or solid foods that slow swallowing and protect the airway.
全球護理師共同具備的「冰淇淋陷阱(Ice cream trap)」常識。在室溫會化成水的東西（冰淇淋、碎冰、果凍），對於被限制只能喝「增稠水」的吞嚥困難中風老人而言，絕對不能碰。