— 生理適應 · EASY · MCQ —
護理師照顧一位正在發作全身僵直-陣攣癲癇的病人，下列何者為發作期間適當的護理措施？
A nurse is caring for a patient experiencing a tonic-clonic seizure. Which nursing action is appropriate during the seizure?
- AAttempt to feed the patient嘗試餵食病人
- BInsert a bite block in the mouth將咬口器放入口中
- CRestrain the patient's limbs約束病人四肢
- DPlace the patient in a side-lying position✓ 正解將病人置於側臥姿勢
— Explanation · 中文詳解 —
癲癇（Seizure）發作期間的護理重點在於「保護病人免受傷害」。全身僵直-陣攣（Tonic-clonic）發作時，病人會有劇烈肌肉收縮。將病人擺向側臥位（Side-lying position）可防止舌頭後墜堵塞氣道，並讓口腔分泌物或嘔吐物流出，預防吸入性肺炎。禁止強制約束肢體或強行放入異物，這些行為極易造成病人骨折或牙齒斷裂。
During a tonic-clonic seizure, the nurse should place the patient in a side-lying position to keep the airway clear and prevent aspiration of secretions or vomit. It is critical to avoid inserting objects into the mouth or restraining the patient, as these actions can cause serious injury such as fractures or dental damage.