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藥理與非經腸給藥 · EASY · MCQ

病人正在進行萬古黴素(Vancomycin)靜脈輸注,護理師發現臉部、頸部及上胸部潮紅。護理師應採取哪項最適當措施?

A client is receiving an IV infusion of vancomycin. The nurse notes flushing of the face, neck, and upper chest. What is the most appropriate action by the nurse?

  • AAdminister an antihistamine immediately
    立即給予抗組織胺
  • BDocument the finding and continue at the same rate
    記錄此發現並以相同速率繼續輸注
  • CSlow the rate of the infusion✓ 正解
    減慢輸注速率
  • DDiscontinue the infusion permanently
    永久停止輸注
Explanation · 中文詳解

萬古黴素(Vancomycin)輸注過快會刺激肥大細胞釋放組織胺,導致「紅人症候群(Red Man Syndrome)」,表現為臉部、頸部及上胸部潮紅、搔癢。這不是真過敏,處理方式只需調慢輸注速率(C)。若直接停藥(D)會延誤抗生素療效,若立即給予抗組織胺(A)則可能隱蔽真正的過敏徵象,且不符合處置原則。護理師應先調慢速率,若症狀持續或惡化再諮詢醫師。

The client is experiencing Red Man Syndrome, a histamine-mediated reaction caused by rapid vancomycin infusion, characterized by flushing of the face, neck, and upper chest. The most appropriate initial nursing action is to slow the infusion rate, which reduces histamine release and alleviates symptoms. This reaction is not a true allergy, so permanent discontinuation is unnecessary, and antihistamines are typically reserved for persistent symptoms or ordered interventions.

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