— 安全與感染控制 · MEDIUM · SATA —
一位有癲癇病史的病人入院。護理師應優先採取哪些措施以確保病人安全？（選所有適合的）
A client with a history of seizures is admitted. Which interventions should the nurse prioritize to ensure patient safety? (Select all that apply.)
- AKeep padded side rails up✓ 正解保持加墊床欄升起
- BMaintain suction equipment at the bedside✓ 正解在床邊備妥抽吸設備
- CRestrain the client during a seizure發作期間約束病人
- DKeep an oral airway at the bedside在床邊備妥口咽通氣道
- EPlace the client in a side-lying position during a seizure✓ 正解發作期間將病人置於側臥位
— Explanation · 中文詳解 —
癲癇（Seizure）發作時的護理核心在於預防受傷及維持呼吸道通暢。護理師應採取保護性措施，如床欄加墊以防撞傷，並準備抽吸設備以應對發作後可能出現的嘔吐或分泌物。發作時應將病人頭部側向一邊，以防止舌頭後墜堵塞呼吸道或吸入嘔吐物。臨床上絕對禁止約束病人，以免造成骨折或肌肉損傷，也不應強行將異物塞入病人口中，以免導致牙齒斷裂或阻塞氣道。
Prioritize safety by keeping padded side rails up to prevent injury and maintaining suction equipment at the bedside to clear secretions. Place the client in a side-lying position during a seizure to prevent aspiration of vomitus or saliva. Do not restrain the client or insert oral airways, as these actions can cause trauma.