— 照護管理 · HARD · MCQ —
一位護理師正在接收入院一位患有敗血症的病人。在識別後的第一小時內，哪項介入措施是優先的？
A nurse is admitting a client with sepsis. Which intervention is a priority within the first hour of recognition?
- AMeasure serum lactate level.測量血清乳酸濃度
- BAdminister intravenous fluids.給予靜脈輸液
- CAdminister broad-spectrum antibiotics.✓ 正解給予廣效型抗生素
- DObtain blood cultures.抽取血液培養
— Explanation · 中文詳解 —
敗血症（Sepsis）的治療關鍵在於「黃金一小時」（Golden Hour）。根據 Surviving Sepsis Campaign 指引，儘早使用廣效性抗生素（Broad-spectrum antibiotics）是降低死亡率最關鍵的單一介入。雖然抽血培養、補液與監測乳酸值都很重要，但若抗生素給予延遲，敗血症會迅速惡化為敗血性休克（Septic shock），導致多重器官衰竭。
According to the Surviving Sepsis Campaign, administering broad-spectrum antibiotics within the first hour is the most critical intervention for reducing mortality in sepsis. While obtaining cultures and fluid resuscitation are important, delaying antibiotic administration significantly increases the risk of progression to septic shock and multiple organ failure.