— 生理適應 · HARD · MCQ —
病患因胸部與手臂燒傷入院。前 24 小時最重要的監測項目為何？
A client is admitted with burns on the chest and arms. Which assessment is the most important to monitor in the first 24 hours?
- AUrine output✓ 正解尿量
- BBody temperature體溫
- CWound appearance傷口外觀
- DPain level疼痛程度
— Explanation · 中文詳解 —
燒傷後前 24-48 小時屬復甦期（Resuscitation phase），最關鍵是維持器官灌流。尿量是反映組織灌流與體液補給是否足夠的最直接指標（標準為 0.5-1 mL/kg/hr），過低則提示休克風險。
Urine output is the most reliable indicator of effective fluid resuscitation and tissue perfusion during the first 24 to 48 hours after a burn injury. Monitoring this metric helps ensure adequate organ function and guides ongoing fluid replacement therapy.
✦ 台美臨床差異
美台皆依據 Parkland formula 計算，但美國燒傷中心護理師對於 titration fluid 的權限較明確。