— 降低風險 · EASY · SATA —
護理師照護一位有癲癇病史的病人,床邊必須準備哪些設備?(選所有適合的)
A nurse is caring for a client with a history of seizures. Which equipment must be available at the bedside? (Select all that apply.)
- AOxygen setup✓ 正解氧氣設備
- BSuction equipment✓ 正解抽吸設備
- CPadded side rails✓ 正解軟墊床欄
- DTongue depressor for airway protection用於保護氣道的壓舌板
- EAmbu bag✓ 正解Ambu bag(自動復甦球)
— Explanation · 中文詳解 —
癲癇發作時的護理重點為維持呼吸道通暢與預防外傷。氧氣、抽吸設備與復甦球(Ambu bag)皆為緊急呼吸道急救所需;襯墊床欄(Padded side rails)則能減少發作時撞擊受傷。注意:現代護理標準明確禁止在發作時將壓舌板強行塞入病人口中(D),此舉極易導致牙齒斷裂或阻塞呼吸道,故不選。
Bedside equipment for a client with seizures must support airway management and physical safety during an episode. Oxygen, suction, and an Ambu bag are essential for maintaining patency and ventilation, while padded side rails help prevent injury from convulsions. Tongue depressors are contraindicated as inserting objects can cause dental damage or airway obstruction.
✦ 台美臨床差異
台美對壓舌板的使用觀念已同步更新,皆採取保護性護理,避免在發作中強制撬開牙關的侵入式處置。