護理師監督一位新進護理師照護膀胱持續灌洗病人，哪項操作顯示需要額外介入指導？
A nurse is supervising a newly licensed nurse who is caring for a client with a continuous bladder irrigation (CBI). Which action by the new nurse indicates a need for further intervention?
- ACalculating the net intake and output by subtracting irrigation volume from total output透過從總輸出量中減去灌洗量來計算淨輸出入量
- BAssessing the tubing for kinks if the drainage stops若引流停止則檢查管路是否有扭結
- CAdjusting the irrigation rate to maintain clear, pink-tinged urine調整灌洗速率以維持尿液清澈帶粉紅色
- DEmptying the drainage bag only when it is completely full to prevent spillage✓ 正解僅在引流袋完全充滿時才排空以防止溢出
膀胱持續灌洗（Continuous Bladder Irrigation, CBI）的主要目的是防止血塊阻塞導尿管，維持尿液引流通暢。引流袋若累積過多液體，不僅會因重量過大造成導尿管牽拉，導致尿道損傷或疼痛，更可能因為引流袋高於膀胱水平而造成尿液逆流（Reflux），增加泌尿道感染風險。護理師應定時清空引流袋，確保負壓引流效能，並精確計算淨輸出量（Net Output），即總輸出量減去灌洗液量。
Waiting until the drainage bag is completely full increases the risk of urine reflux, which can lead to urinary tract infections and bladder distension. Proper management requires emptying the bag regularly to maintain negative pressure and prevent backflow, ensuring safe and effective continuous bladder irrigation. Other actions, such as checking for kinks and calculating net output, are appropriate interventions.