一位85歲患有末期肺癌的男性正在接受安寧緩和醫療，且已陷入毫無反應的昏迷狀態。在他死前的陳施氏呼吸（Cheyne-Stokes）期間，每一次呼氣時，呼吸道深處都會發出巨大、咕嚕咕嚕的水聲（死亡嘎音）。他崩潰的女兒流著淚懇求：「他聽起來就像快被淹死了！拜託妳立刻拿管子把卡在他喉嚨裡的痰全部抽出來；他現在一定非常痛苦！」何為最恰當且最具同理心的護理處置？
An 85-year-old male with terminal lung cancer is receiving hospice care and has slipped into an unresponsive coma. During his agonal Cheyne-Stokes respirations, loud, gurgling fluid sounds ("death rattle") emanate from his respiratory tract upon every exhalation. His distraught daughter pleads in tears, "He sounds like he is drowning! Please take a hose and suction all that mucus out of his throat immediately; he must be suffering terribly!" What is the most appropriate and compassionate nursing response?
- AAdminister high-flow 100% oxygen via a non-rebreather mask to push the accumulating secretions down into the lungs.透過非再呼吸面罩給予高流量 100% 氧氣，將累積的分泌物推入肺部深處。
- BImmediately perform deep nasotracheal suctioning to clear the airway and reassure the daughter.立即進行深層鼻氣管抽吸以清除呼吸道並安撫女兒。
- CExplain that while the sound is distressing to hear, he is not suffering, and then administer prescribed anticholinergic drops while positioning him on his side.✓ 正解解釋雖然聲音令人困擾，但他並未受苦，隨後給予處方抗膽鹼藥物滴劑並將他置於側臥姿勢。
- DState firmly that suctioning violates his "Do Not Resuscitate" (DNR) order, which absolutely prohibits any airway clearance.堅定地表示抽吸違反了他的「拒絕心肺復甦術」（DNR）指示，該指示絕對禁止任何呼吸道清理。
本題測驗安寧緩和照護（End-of-Life / Hospice Care）的最高倫理與舒適度原則。「死亡嘎音（Death rattle / Terminal secretions）」是臨終前極常見的現象。由於吞嚥肌肉完全放鬆失去反射功能，唾液與呼吸道分泌物會堆積在口咽部，導致氣流經過時發出巨大雜音。對家屬而言聽起來像溺水，但實證醫學表明深層昏迷的病患並未因此感到任何窒息痛苦。此時進行深層抽痰（選項B）是錯誤且殘忍的。抽痰機的管子不僅抽不出身處肺部深處的液體，且會造成極大的機械性創傷、疼痛甚至引發嘔吐，嚴重違反安寧「不增加痛苦」理念。正確的作法是：耐心衛教家屬病患並不痛苦以降低其焦慮，然後只需將病患側翻（提供重力引流）或墊高床頭，並可給予醫師開立的抗膽鹼藥物（Anticholinergics，如 Scopolamine/Atropine），這些藥物能主動使口水與呼吸道分泌物乾燥（選項C正確）。選項A高濃度氧氣對瀕死期無效且無助除痰；選項D DNR 僅拒絕壓胸與插管急救，並未拒絕舒適照護，這種衛教缺乏同理心與邏輯。
Terminal secretions causing a 'death rattle' are common in agonal breathing but do not cause distress to the unconscious client. Deep suctioning is contraindicated as it causes trauma and discomfort without effectively clearing deep secretions. The appropriate nursing actions include educating the family that the client is not suffering, repositioning the client to facilitate drainage, and administering prescribed anticholinergic medications to dry secretions.
世界兩大安寧體系均將大聲水泡聲 (Death rattle) 視為必修的家屬哀傷撫慰課題。在台灣的急症安寧，給予 Scopolamine / Atropine 皮下注射或口含滴劑以「烘乾口水」也是非常標準的最後醫療手段。