— 生理適應 · EASY · MCQ —
護理師照護一位血糖為 450 mg/dL 的第一型糖尿病病人,應預期觀察到下列何種臨床表現?
A nurse is caring for a client with type 1 diabetes who presents with a blood glucose level of 450 mg/dL. Which clinical manifestation should the nurse anticipate?
- ABradycardia心動過緩
- BHypertension高血壓
- CDecreased urine output尿量減少
- DDeep, rapid respirations✓ 正解深而快的呼吸
— Explanation · 中文詳解 —
血糖極高且第一型糖尿病病人容易發生酮酸中毒(DKA)。身體為代償代謝性酸中毒,會啟動庫斯莫爾氏呼吸(Kussmaul respirations),表現為深且快的呼吸,試圖透過排出二氧化碳來提升 pH 值。
Clients with type 1 diabetes and significantly elevated blood glucose are at high risk for diabetic ketoacidosis (DKA). To compensate for metabolic acidosis, the body initiates Kussmaul respirations, characterized by deep and rapid breathing, to expel carbon dioxide and raise pH levels.
✦ 台美臨床差異
台美對於 DKA 的監測皆依循標準 Protocol,但美國護理師常需參與 Insulin drip 的精確調整,台灣則多由醫師依數據調配。