— 藥理與非經腸給藥 · HARD · MCQ —
一位病人正在點滴注射萬古黴素 (Vancomycin)。護理師發現病人臉部與頸部潮紅。優先護理措施為何？
A client is receiving Vancomycin infusion. The nurse notes the client has developed flushing of the face and neck. What is the priority nursing intervention?
- ASlow the rate of the infusion✓ 正解減緩輸注速率
- BAdminister an antihistamine immediately立即給予抗組織胺
- CStop the infusion and notify the physician停止輸注並通知醫師
- DIncrease the IV fluid rate to flush the drug增加靜脈輸液速率以沖洗藥物
— Explanation · 中文詳解 —
臉部與頸部潮紅為萬古黴素注射過快引發的「紅人症候群」(Red Man Syndrome)，非過敏反應。處理原則是降低輸注速率，通常潮紅現象會緩解。若出現低血壓或氣管痙攣等嚴重過敏症狀，才需立即停止藥物。
Facial and neck flushing indicates Red Man Syndrome, a histamine-mediated reaction caused by rapid vancomycin infusion rather than a true allergy. The priority intervention is to slow the infusion rate, which typically resolves the symptoms, whereas stopping the medication is reserved for severe anaphylactic reactions.
✦ 台美臨床差異
美台對於萬古黴素輸注速率與紅人症候群的處置共識高度一致，皆強調減速為首要。