— 藥理與非經腸給藥 · EASY · MCQ —
護理師準備給予心衰竭病人 Digoxin，測量心尖脈為 52 次/分。此時最優先的護理處置為何？
A nurse is administering digoxin to a patient with heart failure. Before giving the dose, the nurse assesses an apical pulse of 52 bpm. What is the priority nursing action?
- AAdminister the medication and document the pulse rate給予藥物並記錄脈搏速率
- BAsk the patient to walk around to increase the heart rate請病人走動以增加心率
- CWithhold the dose and notify the healthcare provider✓ 正解暫停給藥並通知醫療提供者
- DAdminister half the dose and recheck in one hour給予半劑量並在一小時後重新測量
— Explanation · 中文詳解 —
Digoxin 具負性變時作用，當成人心跳低於 60 次/分時，必須暫停給藥以避免造成嚴重的竇性心搏過緩或心律不整。護理師應先暫停給藥，並聯絡醫師評估病人是否出現中毒徵兆或需調整劑量。絕對不可擅自減量或要求病人運動，因為這會增加心臟負荷且無助於解決藥物累積問題。
Digoxin has a negative chronotropic effect, and administration should be withheld if the apical pulse is below 60 beats per minute in adults. The nurse must withhold the dose and notify the healthcare provider to prevent severe bradycardia or digoxin toxicity, rather than altering the dose or encouraging physical activity.
✦ 台美臨床差異
台美臨床對於 Digoxin 給藥心跳閾值（通常為 60bpm）的評估標準一致，但美國護理師對醫囑的彈性調整權限較大，台灣則高度依賴醫囑執行。