— 心理社會完整性 · MEDIUM · SATA —
護理師需監測酒精戒斷個案的哪些跡象？（選所有適合的）
Which signs or symptoms should the nurse monitor for in a client who is withdrawing from alcohol? (Select all that apply.)
- ADiaphoresis✓ 正解盜汗
- BTachycardia✓ 正解心跳過速
- CHypotension低血壓
- DTremors✓ 正解震顫
- EAgitation✓ 正解煩躁不安
— Explanation · 中文詳解 —
酒精戒斷症候群（AWS）主要表現為交感神經亢進。症狀包括盜汗、心跳過速、震顫、易怒、激動、高血壓及失眠。C 選項錯誤：酒精戒斷通常導致高血壓而非低血壓，嚴重者可能出現震顫譫妄（DTs）。監測這些指標對預防癲癇發作及嚴重戒斷反應至關重要。
Alcohol withdrawal syndrome is characterized by sympathetic nervous system hyperactivity, resulting in autonomic signs such as diaphoresis, tachycardia, hypertension, and tremors. Psychomotor agitation and insomnia are also common behavioral manifestations. Hypotension is incorrect because withdrawal typically causes elevated blood pressure due to this sympathetic surge.
✦ 台美臨床差異
美國多採用 CIWA-Ar 評分表標準化監測；台灣臨床則較依賴資深護理師臨床經驗觀察。