腫瘤護理師接強化療病患的電話。病患回報強烈關節痛與 38.4°C 的體溫。迫切指令為何？
An oncology nurse answers a phone call from a client undergoing severe active induction chemotherapy. The client reports intense joint pain, profound malaise, and a temperature of 38.4°C (101.1°F). What is the imperative instruction?
- AInstruct the client to take acetaminophen to boldly reduce the fever.指示個案服用乙醯胺酚（acetaminophen）以降低發燒
- BSchedule the client confidently perfectly to visit the outpatient clinic tomorrow.安排個案明天到門診就診
- CAdvise the client to calmly completely remain safely at home resting.建議個案冷靜地留在家中休息
- DMandate the client rapidly present to the emergency department immediately.✓ 正解強制個案立即前往急診室
這道題目考驗護理師對接受化學治療（chemotherapy）病患的緊急狀況判斷與指導能力。接受強化誘導化療的病患，其骨髓抑制（bone marrow suppression）是常見且嚴重的副作用，導致白血球（尤其是嗜中性球，neutrophils）數量急劇下降，形成嗜中性白血球缺乏症（neutropenia）。在嗜中性白血球缺乏症的背景下，體溫38.4°C（101.1°F）加上關節痛和全身不適，極有可能是嗜中性白血球缺乏性發燒（febrile neutropenia）的表現，這是一種醫療急症。此狀況可能迅速進展為敗血症（sepsis）甚至敗血性休克，危及生命，因此需要立即就醫進行評估和廣效性抗生素治療。
Febrile neutropenia is a medical emergency characterized by a temperature of 38.3°C (101°F) or higher in a patient with significantly low neutrophil counts, posing a high risk for rapid progression to sepsis. The nurse must instruct the client to seek immediate emergency evaluation for prompt assessment and administration of broad-spectrum antibiotics.
在台灣和美國，對於化療後病患出現發燒，臨床處理原則都是高度一致的：即視為醫療急症，需立即就醫。嗜中性白血球缺乏性發燒（febrile neutropenia）的診斷標準和治療指引在兩地都遵循國際規範，強調及時的血液培養和廣效性抗生素治療。在美國，腫瘤專科護理師（Oncology Nurse）在電話評估後，有明確的SOP（標準作業流程）指導病患立即前往急診。台灣的護理師也會給予類似的緊急指示，因為這直接關係到病患的生命安全。