— 生理適應 · EASY · MCQ —
一名急性胰臟炎病人禁食並接受靜脈輸液，下列哪項評估發現需要立即處理？
A client with acute pancreatitis is receiving IV fluids and NPO status. Which nursing assessment finding requires immediate intervention?
- ASerum amylase level of 400 U/L血清澱粉酶 400 U/L
- BAbsent bowel sounds腸音消失
- CPain level reported as 6/10 on the numeric scale數字量表報告疼痛程度 6/10
- DRespiratory rate of 28 breaths/min with decreased SpO2✓ 正解呼吸頻率 28 次/分伴隨 SpO2 下降
— Explanation · 中文詳解 —
急性胰臟炎病人常因嚴重的發炎反應與腹部疼痛，導致橫膈膜活動受限，進而產生肺部併發症（如肋膜積水、肺不張）。呼吸急促（Tachypnea）伴隨氧飽和度下降（Desaturation）代表病人出現呼吸功能衰竭的風險，依照 ABC（Airway, Breathing, Circulation）原則，呼吸問題必須優先於疼痛或檢驗數值異常進行處理。
Respiratory distress, indicated by tachypnea and decreased oxygen saturation, is a critical complication of acute pancreatitis often resulting from pleural effusion or atelectasis. According to ABC priorities, maintaining airway and breathing takes precedence over expected lab abnormalities or pain management.