— 降低風險 · HARD · SATA —
針對骨盆骨折的病人，下列哪些評估發現應優先處理？（選所有適合的）
Which assessment findings in a client with a pelvic fracture should the nurse prioritize? (Select all that apply.)
- AHematuria✓ 正解血尿
- BHypotension and tachycardia✓ 正解低血壓與心搏過速
- CInability to move the legs無法移動雙腿
- DBruising in the flank area✓ 正解側腹部瘀青
- EStable respiratory rate穩定的呼吸速率
— Explanation · 中文詳解 —
骨盆骨折（Pelvic fracture）常伴隨大量內出血與內臟損傷，護理重點在於循環監測與內臟保護。低血壓與心搏過速為休克徵象（Shock），血尿（Hematuria）暗示泌尿系統損傷（常見於骨盆骨折），側腹瘀青（Grey Turner's sign）則暗示腹膜後出血。這些均是危及生命的徵兆，需優先處理。
Pelvic fractures often cause significant internal bleeding and organ damage, making hemodynamic stability and urinary integrity priorities. Hypotension and tachycardia indicate hypovolemic shock, while hematuria suggests bladder or urethral injury. Flank bruising (Grey Turner’s sign) signals retroperitoneal hemorrhage, all of which require immediate intervention compared to stable respiratory rates or non-acute nerve symptoms.