— 生理適應 · HARD · MCQ —
護理師監測甲狀腺切除術後病患，下列哪項發現需立即通知醫師？
A nurse is monitoring a client post-thyroidectomy. Which assessment finding requires immediate notification to the provider?
- AHoarseness when speaking說話時聲音沙啞
- BEdema at the neck dressing頸部敷料處水腫
- CPain at the incision site切口處疼痛
- DPositive Chvostek sign✓ 正解Chvostek 徵象陽性
— Explanation · 中文詳解 —
甲狀腺切除時若誤傷副甲狀腺，會導致急性低血鈣。Chvostek 徵象陽性是早期低血鈣的神經肌肉興奮指標，可能引發喉頭痙攣導致呼吸道阻塞。雖喉頭水腫和出血也危險，但早期發現電解質失衡對預防心律不整與痙攣至關重要。
A positive Chvostek sign indicates acute hypocalcemia, likely resulting from accidental damage to the parathyroid glands during thyroidectomy. This electrolyte imbalance increases neuromuscular excitability and can lead to life-threatening complications such as laryngospasm and cardiac arrhythmias.
✦ 台美臨床差異
美台對低血鈣的監測皆列為重點，但美國對於術後早期出院的監測 protocol 較為嚴格。