— 心理社會完整性 · EASY · MCQ —
一位 25 歲患有廣泛性焦慮症的病人前來診所，主訴心悸、呼吸困難及瀕死感。護理師應優先採取何種措施？
A 25-year-old client with a history of generalized anxiety disorder presents to the clinic with reports of heart palpitations, shortness of breath, and a fear of impending doom. Which intervention is the highest priority?
- AAdminister an ordered PRN anxiolytic medication給予醫囑之備用抗焦慮藥物
- BPerform a comprehensive mental status examination進行全面的精神狀態檢查
- CInstruct the client to breathe deeply and slowly✓ 正解指示病人深呼吸並放慢速度
- DAsk the client to describe the triggers for these symptoms詢問病人描述這些症狀的誘發因素
— Explanation · 中文詳解 —
面對急性焦慮發作，首要目標是緩解生理不適並穩定病人的自主神經系統。深呼吸能有效刺激迷走神經，降低交感神經興奮，使病人重新獲得對身體的控制感。其他選項如給藥、探討成因或進行評估，均需在急性症狀緩解後才進行，而非當下最即時的處置。
The highest priority intervention for a client experiencing acute panic is to instruct deep, slow breathing to calm the autonomic nervous system and reduce physiological arousal. This non-pharmacological approach provides immediate stabilization and helps the client regain a sense of control before other assessments or medications are administered.
✦ 台美臨床差異
美台護理師皆強調急性期非藥物介入，但在台灣，護理師通常會更早尋求醫師評估是否需要給予鎮靜藥物。