— 藥理與非經腸給藥 · EASY · MCQ —
病人正在靜脈滴注萬古黴素，護理師發現病人臉部、頸部及上半身潮紅。護理師應優先採取什麼行動？
A client is receiving an IV infusion of vancomycin. The nurse notes the client develops flushing of the face, neck, and upper torso. What is the priority nursing action?
- AObtain blood pressure and pulse測量血壓和脈搏
- BAdminister an antihistamine給予抗組織胺
- CStop the infusion immediately立即停止輸注
- DSlow the rate of the infusion✓ 正解減慢輸注速度
— Explanation · 中文詳解 —
此為典型的「紅人症候群」(Red Man Syndrome)，源於萬古黴素滴注過快引起的組織胺釋放。並非真正的過敏反應，故不必停止滴注，僅需減慢滴注速率即可緩解症狀。若有嚴重低血壓，則需停藥並通知醫師，但在症狀輕微時優先調整速度。
The client is experiencing Red Man Syndrome, a histamine-mediated reaction caused by rapid vancomycin infusion rather than a true allergy. The priority nursing action is to slow the infusion rate, which typically resolves the flushing and prevents progression to more severe symptoms like hypotension.
✦ 台美臨床差異
台美對紅人症候群的處置一致，強調緩慢滴注以預防發生。