— 基本照護與舒適 · MEDIUM · SATA —
護理師為需要臥床的病人制定護理計畫，下列哪些介入措施能預防不動帶來的併發症？（選所有適合的）
A nurse is creating a plan of care for a client requiring bed rest. Which interventions are appropriate for preventing complications of immobility? (Select all that apply.)
- APerform passive range-of-motion exercises✓ 正解執行被動關節活動運動
- BEncourage deep breathing and coughing exercises✓ 正解鼓勵深呼吸與咳嗽運動
- CMaintain the client in a high-Fowler's position at all times始終讓病人維持高福勒氏臥位
- DApply sequential compression devices (SCDs)✓ 正解應用循序加壓裝置 (SCDs)
- EIncrease fluid intake within prescribed limits✓ 正解在規定範圍內增加液體攝取量
— Explanation · 中文詳解 —
長期臥床易導致肌肉萎縮、肺炎、血栓及便秘。透過運動改善循環、呼吸訓練預防肺部塌陷、穿戴 SCD 預防深部靜脈栓塞及補充足夠水分，是綜合護理的核心。C 錯誤：持續維持高坐位會對尾骶骨造成過大壓力，增加壓瘡風險。
Appropriate interventions for clients on bed rest include performing passive range-of-motion exercises, encouraging deep breathing and coughing, applying sequential compression devices, and increasing fluid intake within prescribed limits. These actions help maintain joint flexibility, prevent respiratory complications like atelectasis, reduce DVT risk, and prevent constipation and renal stasis.
✦ 台美臨床差異
美國醫院常見使用 SCD，台灣則除設備外常合併使用彈性襪，且鼓勵早日下床活動的理念一致。