— 基本照護與舒適 · MEDIUM · SATA —
下列哪些護理措施可提升癲癇病史病人的安全性？（選所有適合的）
Which of the following nursing interventions promote client safety in a client with a history of seizures? (Select all that apply.)
- AKeep the bed in the lowest position✓ 正解將病床調整至最低位置
- BKeep side rails up at all times✓ 正解隨時拉起床欄
- CPlace a padded tongue blade at the bedside在床邊放置軟墊舌壓板
- DKeep suction equipment ready✓ 正解備妥抽吸設備
- ELoosen clothing around the neck✓ 正解鬆開頸部衣物
— Explanation · 中文詳解 —
癲癇發作時的護理重點為預防受傷與保持呼吸道通暢。床位放低防止墜床，拉起護欄避免掉落，準備抽吸設備以利處理分泌物，鬆開頸部衣物確保呼吸空間。切勿將任何物體（如舌壓板）塞入病人口中，以免造成牙齒斷裂或阻塞呼吸道。
To ensure client safety during a seizure, nurses should keep the bed in the lowest position with side rails up to prevent falls, loosen tight clothing around the neck to facilitate breathing, and have suction equipment ready to clear secretions and prevent aspiration. Padded tongue blades are contraindicated as they pose a risk of dental trauma and airway obstruction.
✦ 台美臨床差異
美國護理指引已明確禁止在發作時使用舌壓板，台灣臨床教育也在逐步更新此舊觀念。