— 生理適應 · MEDIUM · MCQ —
病人胸管意外與引流系統脫落，護理師應採取什麼行動？
A nurse is caring for a client with a chest tube. Which action should the nurse take if the chest tube becomes disconnected from the drainage system?
- APlace the end of the tube in sterile water✓ 正解將導管末端置入無菌水中。
- BClamp the chest tube夾閉胸管。
- CCover the site with a dry dressing以乾燥敷料覆蓋傷口。
- DCall the physician immediately立即通知醫師。
— Explanation · 中文詳解 —
當胸管脫落時，首要目標是恢復胸膜腔的密封狀態，防止氣體進入造成張力性氣胸（Tension Pneumothorax）。將管末端置入無菌水中可建立水封（Water seal），讓氣體能排出但不會進入胸腔。選項B夾住胸管極危險，因為胸腔內產生的氣體無法排出，會迅速導致致命的張力性氣胸。選項D應在緊急處理後執行，而非第一優先動作。
Safety and risk reduction, particularly regarding driving and substance use, should be prioritized in adolescent health promotion. Accidents and substance abuse are leading causes of morbidity and mortality in this age group due to developmental factors like impulsivity. Topics such as assisted living, dementia prevention, and retirement planning are relevant to older adult populations rather than adolescents.