— 生理適應 · MEDIUM · SATA —
護理師評估疑似深部靜脈栓塞（DVT）的病人，哪些發現與之相符？（選所有適合的）
A nurse is assessing a client with suspected deep vein thrombosis (DVT). Which assessment findings are consistent with DVT? (Select all that apply.)
- AUnilateral leg swelling✓ 正解單側腿部腫脹
- BRedness along the vein pathway✓ 正解沿著靜脈路徑的紅斑
- CPain in the affected calf✓ 正解患側小腿疼痛
- DCoolness of the extremity肢體冰冷
- EPositive Homans' sign (no longer reliable as a diagnostic tool)霍曼氏徵象陽性（已不再作為可靠的診斷工具）
— Explanation · 中文詳解 —
DVT 典型的臨床表現包含患肢單側腫脹、疼痛、發紅及觸摸到變硬的靜脈軌跡。雖 Homans' sign 曾被廣泛使用，但現代臨床認為其可靠度不足且恐造成血栓脫落，不應作為診斷依據。肢體冰冷則通常指向動脈缺血，而非靜脈栓塞。
Assessment findings consistent with deep vein thrombosis include unilateral leg swelling, redness along the vein, and calf pain due to venous obstruction and inflammation. Coolness of the extremity suggests arterial insufficiency rather than venous thrombosis, and Homans' sign is no longer recommended due to its unreliability and potential to dislodge the clot.
✦ 台美臨床差異
兩地均已極少使用 Homans' sign 進行診斷，現代多採 Wells score 進行風險評估。