— 生理適應 · HARD · SATA —
低血鉀病患出現哪些評估結果需要立即醫療介入?(選所有適合的)
Which assessment findings in a client with hypokalemia require immediate intervention? (Select all that apply.)
- APresence of U waves on the ECG✓ 正解心電圖出現U波
- BMuscle weakness and lethargy肌肉無力與嗜睡
- CShallow respirations✓ 正解呼吸淺快
- DHyperactive bowel sounds腸蠕動音亢進
- EDecreased deep tendon reflexes✓ 正解深層肌腱反射減弱
— Explanation · 中文詳解 —
低血鉀會影響神經肌肉傳導與心肌細胞極化。U 波為典型的心電圖變化。呼吸肌無力導致淺快呼吸,威脅生命安全。深部腱反射減弱顯示神經肌肉抑制,皆為緊急徵兆。B雖為低血鉀症狀,但與心肺功能異常相比,優先級較低。
Hypokalemia can cause life-threatening cardiac dysrhythmias indicated by U waves on the ECG and respiratory muscle weakness leading to shallow breathing. It also results in decreased deep tendon reflexes due to neuromuscular inhibition, requiring immediate intervention.
✦ 台美臨床差異
美國護理師常需依據監測數據即時與醫師討論補鉀速率,台灣則多嚴格遵循醫囑滴注規範。