— 基本照護與舒適 · MEDIUM · MCQ —
護理師照顧一位持續灌食的病人，應採取何種姿勢以降低吸入性肺炎風險？
A nurse is caring for a client with a continuous tube feeding. Which position should the nurse maintain to minimize the risk of aspiration?
- AHigh-Fowler's at 60 degrees抬高床頭至 60 度的福勒氏體位
- BSupine仰臥
- CLeft lateral recumbent左側臥位
- DSemi-Fowler's at 30 to 45 degrees✓ 正解抬高床頭 30 至 45 度的半福勒氏體位
— Explanation · 中文詳解 —
持續管灌（Continuous tube feeding）的病人面臨極高的吸入性肺炎（Aspiration pneumonia）風險。根據臨床實證，將床頭抬高（Head of bed elevation）至 30 到 45 度，利用重力作用減少胃內容物逆流至食道的機率，是預防吸入性風險的核心護理措施。過高的角度可能導致病人身體下滑，反而增加皮膚摩擦力與壓力性損傷風險，因此 30-45 度是最理想的配置。
Maintaining the head of the bed at 30 to 45 degrees (Semi-Fowler's) utilizes gravity to minimize gastric reflux and reduce the risk of aspiration during continuous tube feeding. Higher angles may cause patient slippage and skin injury, while supine positioning significantly increases the risk of reflux and aspiration pneumonia.