— 生理適應 · EASY · MCQ —
護理師照護一位有吞嚥困難 (dysphagia) 的中風病人。哪項護理措施對預防吸入性肺炎至關重要？
A nurse is caring for a client with a history of stroke who has dysphagia. Which nursing intervention is crucial to prevent aspiration?
- AOffer thin liquids提供稀薄液體
- BAvoid thickened liquids避免使用增稠液體
- CPosition the client in a semi-Fowler's position✓ 正解將病人置於半坐臥位 (semi-Fowler's position)
- DFeed the client quickly快速餵食病人
— Explanation · 中文詳解 —
吞嚥困難（dysphagia）病人因保護性反射減弱，極易發生吸入性肺炎（aspiration pneumonia）。護理的核心策略是利用重力輔助吞嚥，並確保呼吸道通暢。將病人維持在半坐臥（semi-Fowler's）或高坐臥位（high-Fowler's）是標準預防措施。此外，食物質地需調整（如增稠液體），進食速度應緩慢且給予充分咀嚼時間，以減少誤吸風險。
Positioning the client in a semi-Fowler's or high-Fowler's position uses gravity to facilitate swallowing and keep the airway open, significantly reducing the risk of aspiration. This intervention is crucial for clients with dysphagia to ensure safe eating and prevent complications like aspiration pneumonia.