— 安全與感染控制 · EASY · MCQ —
護理師採取下列哪項措施最能落實預防高齡病人跌倒的原則？
Which of the following interventions by the nurse best demonstrates the principle of preventing falls for an elderly client?
- ARaising all four side rails升起所有四個床欄
- BEncouraging the client to walk barefoot鼓勵病人赤腳行走
- CPlacing a restraint on the client to limit movement對病人使用約束具以限制活動
- DKeeping the bed in the lowest position✓ 正解保持病床處於最低位置
— Explanation · 中文詳解 —
預防跌倒的首要目標是降低環境風險，將床位調至最低（Lowest position）可縮短病人下床時的距離，減少受傷風險。四邊床欄全起通常被視為限制行動的約束，需醫師醫囑。赤腳容易打滑，穿止滑鞋較安全。約束物會增加病人躁動與摔傷風險，非預防跌倒首選。
Keeping the bed in the lowest position is a key fall prevention strategy because it minimizes the distance a client might fall, thereby reducing the severity of potential injuries. Raising all side rails is considered a restraint, while barefoot walking and restraints increase the risk of slips and agitation-related falls.
✦ 台美臨床差異
台美對「床欄」定義略有不同，美國嚴格將四邊床欄歸類為物理性約束（Physical Restraint），台灣臨床實務上四邊床欄使用較頻繁。