— 照護管理 · MEDIUM · MCQ —
一位護理師正在照護一位慢性阻塞性肺病（COPD）病人，病人出現呼吸短促加劇。護理師應優先採取哪項措施？
A nurse is caring for a client with COPD who is experiencing increased shortness of breath. Which action should the nurse take first?
- AObtain an arterial blood gas sample.取得動脈血液氣體樣本
- BAdminister oxygen at 2 L/min via nasal cannula.✓ 正解經鼻導管給予 2 L/min 的氧氣
- CNotify the physician.通知醫師
- DPrepare for immediate intubation.準備立即插管
— Explanation · 中文詳解 —
COPD 急性發作首重低流量氧氣（1-2 L/min）將 SpO2 維持在 88-92%。COPD 病人依賴缺氧驅動呼吸，高流量氧氣會抑制呼吸中樞。B（插管）為保守治療無效後的選項；C（通知醫師）、A（抽血氣）均為後續步驟，緊急處置以穩定 ABC 為先。
Administering low-flow oxygen (1-2 L/min) is the priority to correct hypoxemia without suppressing the hypoxic respiratory drive in COPD patients. Obtaining arterial blood gases and notifying the physician are subsequent steps after stabilizing the airway and breathing.
✦ 台美臨床差異
美國護理師可依 protocol 自行調整氧流量；台灣多需醫囑授權，但緊急情況可先給予低流量氧氣再補開醫囑。