— 生理適應 · HARD · MCQ —
照護 SIADH 病人,哪項護理行動為首要?
A nurse is caring for a client with SIADH. Which nursing action is priority?
- AImplement fluid restrictions✓ 正解實施液體限制
- BEncourage fluid intake鼓勵攝取液體
- CMonitor serum sodium監測血清鈉濃度
- DAdminister diuretics給予利尿劑
— Explanation · 中文詳解 —
SIADH(抗利尿激素不適當分泌症候群)的病理生理機轉是體內分泌過多 ADH,導致腎臟過度重吸收水分,造成稀釋性低血鈉與體液過多。因此,治療的核心策略是「限制液體攝取(fluid restrictions)」,以減少水分負擔並逐步提升血鈉濃度。護理師應嚴格監測病人的輸入與輸出(I&O)、體重變化以及神經學狀態(低血鈉可能導致腦水腫)。
SIADH causes excessive water retention and dilutional hyponatremia due to inappropriate ADH secretion. Therefore, fluid restriction is the primary treatment to reduce water burden and gradually raise serum sodium levels.