— 心理社會完整性 · MEDIUM · SATA —
護理師觀察急性酒精戒斷症候群時，預期會出現哪些症狀？（選所有適合的）
Which assessment findings should the nurse expect in a client experiencing acute alcohol withdrawal syndrome? (Select all that apply.)
- ATremors✓ 正解震顫
- BDiaphoresis✓ 正解盜汗
- CBradycardia心搏過緩
- DHypertension✓ 正解高血壓
- EHallucinations✓ 正解幻覺
— Explanation · 中文詳解 —
酒精戒斷症候群呈現交感神經亢進狀態，表現包括手抖（Tremors）、盜汗（Diaphoresis）、高血壓（Hypertension）與心搏過速（Tachycardia），而非心搏過緩。嚴重者可能出現幻覺（Hallucinations）或譫妄。監測生命徵象是護理照護之關鍵。
Acute alcohol withdrawal syndrome typically presents with signs of sympathetic hyperactivity, including tremors, diaphoresis, hypertension, and tachycardia. Severe cases may also involve hallucinations, whereas bradycardia is not expected as it contradicts the physiological stress response associated with withdrawal.
✦ 台美臨床差異
兩地均採用 CIWA-Ar 量表評估，護理師在兩地皆有權責根據評估分數決定給藥劑量。