— 生理適應 · EASY · SATA —
哪些評估結果顯示病人正處於體液容積不足狀態？（選所有適合的）
Which assessment findings indicate that a client is experiencing a fluid volume deficit? (Select all that apply.)
- AHeart rate 118 beats per minute✓ 正解心率每分鐘 118 次
- BBlood pressure 100/60 mmHg✓ 正解血壓 100/60 mmHg
- CSerum osmolality 310 mOsm/kg✓ 正解血清滲透壓 310 mOsm/kg
- DUrine specific gravity 1.035✓ 正解尿液比重的 1.035
- EPeripheral edema 2+周邊水腫 2+
— Explanation · 中文詳解 —
體液容積不足（脫水）會導致代償性心跳加速、血壓下降。體內水分減少會使血液濃縮，導致血滲透壓上升（>295 mOsm/kg）及尿比重增加（>1.030，顯示尿液濃縮）。外周水腫代表體液容積過多（Fluid Volume Overload）。
Skipping meals can cause unstable blood glucose levels and hypoglycemia, while reusing needles increases the risk of infection and tissue damage. During hypoglycemia, fast-acting carbohydrates like juice or glucose tablets are preferred over complex carbohydrates to ensure rapid absorption. Rotating injection sites and daily foot checks are correct management practices.
✦ 台美臨床差異
美台護理評估體液平衡皆高度依賴生命徵象與實驗數據，但台灣護理紀錄對於尿比重與血滲透壓的解釋更依賴檢驗單報告。