— 照護管理 · HARD · SATA —
護理師照護一位簽署 DNR 的病人，病人呼吸與脈搏停止，護理師應採取哪些行動？（選所有適合的）
A nurse is caring for a client who has a DNR order. The client stops breathing and has no pulse. Which action should the nurse take? (Select all that apply.)
- ADo not initiate cardiopulmonary resuscitation (CPR)✓ 正解不要開始心肺復甦術 (CPR)
- BNotify the family immediately✓ 正解立即通知家屬
- CCall the physician to pronounce the death✓ 正解呼叫醫師宣告死亡
- DDocument the time of death in the chart✓ 正解在病歷中記錄死亡時間
- EStart oxygen therapy immediately立即開始氧氣治療
— Explanation · 中文詳解 —
DNR（Do Not Resuscitate）醫囑僅針對心肺復甦術（CPR），包括胸部按壓、人工呼吸、電擊與給予急救藥物，並不代表放棄其他照護。當病人死亡時，護理師應轉向「舒適照護（Comfort Care）」與「臨終關懷（End-of-Life Care）」，並遵循法律與機構流程進行後續程序，包括聯繫醫師宣告死亡及通知家屬。
With a DNR order, the nurse must not initiate CPR, intubation, or other resuscitative measures such as oxygen therapy when the client stops breathing and has no pulse. The nurse should notify the family immediately, call the physician to pronounce death, and document the time of death in the chart while providing comfort care.
✦ 台美臨床差異
在美國，DNR 醫囑非常嚴格，護理師若未經醫師同意擅自違背 DNR 進行急救，可能面臨法律訴訟。台灣臨床實務對 DNR 的執行常受家屬壓力干擾，但在美國 NCLEX 考試中，必須嚴格遵循病人法律意願。