末期腎病病人血鉀 7.2 mEq/L 且有心電圖變化。護理師預期應先給予哪種藥物以保護心臟？
A client with end-stage renal disease (ESRD) has a potassium level of 7.2 mEq/L and ECG changes. Which medication should the nurse expect to administer first to protect the heart?
- AFurosemide呋塞米
- BRegular insulin and dextrose常規胰島素與葡萄糖
- CCalcium gluconate✓ 正解葡萄糖酸鈣
- DSodium polystyrene sulfonate聚苯乙烯磺酸鈉
末期腎病（End-Stage Renal Disease, ESRD）病人由於腎臟功能嚴重受損，無法有效排泄鉀離子，因此容易發生高血鉀症（hyperkalemia）。當血鉀濃度高達 7.2 mEq/L，且伴有心電圖（ECG）變化（例如高聳 T 波、PR 間期延長、QRS 變寬），表示高血鉀已對心肌細胞的電生理活動產生顯著影響，可能引發致命性心律不整。在此危急情況下，護理師的首要目標是「立即穩定心肌細胞膜」，以防止惡性心律不整的發生。 葡萄糖酸鈣（Calcium gluconate）是此時的急救首選藥物。它能迅速（數分鐘內）拮抗鉀離子對心肌的抑制作用，穩定心肌細胞膜電位，但它不直接降低血鉀濃度。其他藥物雖然能降低血鉀，但作用速度較慢，無法提供立即的心臟保護。因此，確保心臟穩定是處理急性高血鉀的最高優先順序。
Clients with end-stage renal disease (ESRD) cannot effectively excrete potassium because of severe renal dysfunction and are prone to hyperkalemia. When serum potassium reaches 7.2 mEq/L with ECG changes (e.g., peaked T waves, prolonged PR, widened QRS), hyperkalemia is markedly affecting myocyte electrophysiology and can trigger lethal arrhythmias. The nurse's first goal is to immediately stabilize the cardiac cell membrane to prevent malignant arrhythmias. Calcium gluconate is the first-line emergency drug in this situation. It rapidly (within minutes) antagonizes potassium's effect on the heart and stabilizes the myocyte membrane potential, but it does not directly lower the serum potassium level. The other drugs lower potassium but act more slowly and do not provide immediate cardiac protection. Stabilizing the heart is the top priority in acute hyperkalemia.