— 基本照護與舒適 · EASY · SATA —
護理師照護一位高體溫病人。下列哪些措施有助於促進散熱？（選所有適合的）
A nurse is caring for a client with hyperthermia. Which of the following interventions are appropriate for promoting heat loss? (Select all that apply.)
- AApplying tepid water sponges to the skin✓ 正解以溫水擦拭皮膚
- BIncreasing the ambient room temperature增加室內環境溫度
- CEncouraging increased oral fluid intake✓ 正解鼓勵增加口服液體攝取
- DRemoving excess clothing and blankets✓ 正解移除多餘衣物與毯子
- EApplying ice packs directly to the skin將冰袋直接敷於皮膚上
— Explanation · 中文詳解 —
高體溫（Hyperthermia）的護理重點在於透過物理方式促進熱量散失。散熱機制包括傳導（Conduction）、對流（Convection）、蒸發（Evaporation）及輻射（Radiation）。護理措施應著重於增加這些散熱途徑，並避免引發寒顫（Shivering），因為寒顫會導致代謝增加、耗氧量上升並產生更多熱能，反而讓病人的體溫更難控制。
Interventions such as applying tepid water sponges, encouraging oral fluids, and removing excess clothing promote heat loss through evaporation, hydration support, and radiation/convection, respectively. These measures help dissipate body heat without inducing shivering, which would increase metabolic rate and heat production.