護理師正在照護一位甲狀腺全切除術後 4 小時的病人。下列哪項發現是護理師為降低潛在併發症風險而必須最優先監測的？
A nurse is caring for a client who is 4 hours post-operative following a total thyroidectomy. Which finding is the most critical for the nurse to monitor to reduce the risk of potential complications?
- ATingling of the fingers and toes or around the mouth✓ 正解手指、腳趾或口周有麻刺感
- BHyperactive bowel sounds and mild abdominal cramping腸音亢進伴隨輕微腹部痙攣
- CSlight hoarseness when speaking to the nurse與護理師交談時聲音略微沙啞
- DClient report of 4/10 pain at the incision site病人報告切口處疼痛程度為4/10
甲狀腺切除術後最危險且需立即處理的併發症之一是副甲狀腺受損導致的急性低血鈣。副甲狀腺通常位於甲狀腺後方，手術中可能被誤切或因血流受阻受損。低血鈣會增加神經肌肉的興奮性，初期症狀（Tingling/Paresthesia）通常出現在手指、腳趾或口唇周圍。如果不立即處理，可能進展為喉痙攣（Laryngospasm）、癲癇或心律不整。雖然喉返神經受損會導致聲音沙啞（C），但輕微沙啞在插管後常見，而低血鈣引發的肌肉抽搐具有致命風險。護理師應評估 Chvostek’s 和 Trousseau’s 徵象，並準備好葡萄糖酸鈣（Calcium Gluconate）作為急救。此題體現了「風險降低」核心：識別早期徵象以預防生理性失代償。
The nurse must prioritize monitoring for tingling in the fingers, toes, or around the mouth, as this is an early sign of hypocalcemia caused by accidental damage to the parathyroid glands during surgery. Hypocalcemia increases neuromuscular excitability and can rapidly progress to life-threatening complications such as laryngospasm, seizures, or cardiac arrhythmias. While hoarseness may occur due to intubation or nerve irritation, it is not as immediately dangerous as signs of tetany or airway compromise.
在美國護理實務中，若發現術後病人出現麻刺感，護理師有權依據 Protocol 直接啟動低血鈣評估並準備急救藥物；台灣護理師通常會先量測血壓、觀察徵象後通報住院醫師，由醫師開立 Calcium 檢驗後再執行給藥。