— 生理適應 · MEDIUM · SATA —
一位病人被診斷為低鉀血症，護理師在評估時應預期發現哪些徵象？（選所有適合的）
A client is diagnosed with hypokalemia. Which manifestations should the nurse expect to find during the assessment? (Select all that apply.)
- AMuscle weakness✓ 正解肌肉無力
- BHyperactive deep tendon reflexes深層肌腱反射亢進
- CDecreased bowel sounds✓ 正解腸鳴音減弱
- DCardiac dysrhythmias✓ 正解心律不整
- ETall, peaked T waves高大尖銳的T波
— Explanation · 中文詳解 —
鉀離子（Potassium）是細胞內主要陽離子，參與神經傳導與肌肉收縮。低鉀血症（Hypokalemia）導致細胞膜超極化（Hyperpolarization），神經肌肉刺激性降低，進而引起肌肉無力（Muscle weakness）與腸胃道平滑肌收縮力下降（導致腸鳴音減少）。此外，心肌電位不穩定會誘發多種心律不整（Cardiac dysrhythmias）。高鉀血症才會出現 T 波高尖（Tall, peaked T waves）。
Hypokalemia reduces neuromuscular excitability, leading to skeletal muscle weakness and decreased smooth muscle contraction, which manifests as diminished bowel sounds. Additionally, low potassium levels destabilize cardiac cell membranes, increasing the risk of dysrhythmias, whereas tall peaked T waves are a sign of hyperkalemia.