— 生理適應 · HARD · MCQ —
一位診斷為急性呼吸窘迫症候群（ARDS）的病人，護理師應預期出現何種臨床表現？
A client is diagnosed with acute respiratory distress syndrome (ARDS). Which clinical manifestation should the nurse anticipate?
- AHypercapnia leading to respiratory alkalosis導致呼吸性鹼中毒的高碳酸血症
- BIncreased lung compliance肺部順應性增加
- CRefractory hypoxemia✓ 正解難治性低氧血症
- DProductive cough with thick yellow sputum伴有濃稠黃痰的產痰性咳嗽
— Explanation · 中文詳解 —
ARDS 的典型生理特徵是頑固性低血氧（Refractory hypoxemia），即給予高濃度氧氣仍無法改善低血氧，主因是肺泡萎陷及肺水腫導致嚴重的分流（Shunting）。肺部順應性會下降而非增加；初期多為呼吸性鹼中毒（過度換氣），而非酸中毒；該疾病並非細菌感染引起，不會出現膿痰。
Refractory hypoxemia is the hallmark clinical manifestation of ARDS, resulting from severe intrapulmonary shunting due to alveolar collapse and edema that does not improve with supplemental oxygen. Unlike conditions causing increased lung compliance, ARDS leads to stiff lungs, and early stages often present with respiratory alkalosis rather than acidosis.
✦ 台美臨床差異
美國護理師在 ARDS 病人照護中常參與俯臥位治療（Prone positioning）的執行，台灣通常由呼吸治療師協助。