— 降低風險 · MEDIUM · MCQ —
護理師為一位中性白血球減少並發燒的病人擬定護理計畫。下列哪項措施優先級最高？
A nurse is planning care for a client with a neutropenic fever. Which action is the highest priority?
- AAdminister broad-spectrum antibiotics as prescribed依醫囑給予廣效型抗生素
- BMonitor vital signs every 4 hours每 4 小時監測生命徵象
- CObtain blood, urine, and sputum cultures✓ 正解採集血液、尿液和痰液培養
- DInitiate strict hand hygiene and isolation precautions實施嚴格的手部衛生和隔離 precautions
— Explanation · 中文詳解 —
中性白血球減少性發燒（Neutropenic fever）被視為腫瘤科急症。首要原則是「診斷優先於治療」，必須在給予抗生素前先採集各項檢體（血、尿、痰），以確保細菌培養準確度。若先給抗生素會導致培養偽陰性，影響後續精準用藥。D 與 A 為後續重要步驟，但先採檢才能確保後續治療有效。
In neutropenic fever, obtaining cultures before administering antibiotics is the highest priority to accurately identify the causative organism. Administering antibiotics first can result in false-negative culture results, compromising targeted treatment.
✦ 台美臨床差異
美台對於 Neutropenic fever 的「一小時內給抗生素」原則一致，台灣醫療現場對於檢體流程更為嚴格。