— 心理社會完整性 · MEDIUM · SATA —
一位個案出現酒精戒斷症狀，哪些發現需要立即回報醫師？（選所有適合的）
A client is experiencing symptoms of alcohol withdrawal. Which observations should be reported to the provider immediately? (Select all that apply.)
- ABlood pressure 160/98 mmHg✓ 正解血壓 160/98 mmHg
- BVisual hallucinations✓ 正解視幻覺
- CSlight tremors of the hands手部輕微顫抖
- DDisorientation to time and place✓ 正解對時間和地點失去定向力
- EHeart rate 115 bpm✓ 正解心率 115 bpm
— Explanation · 中文詳解 —
酒精戒斷譫妄（Delirium Tremens）是危險的醫學緊急狀況。血壓升高、心跳過速均暗示自主神經系統功能亢進；幻覺與定向感喪失則顯示病情已進展至譫妄階段，隨時可能發生癲癇或心臟併發症。手部微震雖為戒斷常見現象，但若非惡化期則通常依賴標準化評估表監測，不需立即報備。
Hypertension, tachycardia, visual hallucinations, and disorientation are critical signs of autonomic instability and progression to delirium tremens, requiring immediate provider notification. These symptoms indicate severe alcohol withdrawal that can lead to seizures or cardiovascular collapse. While mild tremors are expected, the combination of vital sign changes and altered mental status represents a medical emergency.
✦ 台美臨床差異
美國常使用 CIWA-Ar 評分表標準化處理，台灣醫療機構評估工具普及率不一。