— 降低風險 · HARD · SATA —
護理師準備為病人靜脈輸注氯化鉀。護理師應採取哪些措施？（選所有適合的）
A nurse is preparing to administer intravenous potassium chloride to a client. Which actions should the nurse perform? (Select all that apply.)
- AVerify that the infusion is diluted in appropriate fluid✓ 正解確認輸注液已適當稀釋
- BAdminister the medication as a rapid IV push作為快速靜脈推注給藥
- CMonitor the infusion site for signs of phlebitis✓ 正解監測輸注部位是否有靜脈炎跡象
- DEnsure the client has adequate urine output✓ 正解確保個案有足夠的尿量
- EUse an electronic infusion pump for administration✓ 正解使用電子輸液幫浦進行給藥
— Explanation · 中文詳解 —
靜脈輸注鉀離子極具危險性，絕不可直接 IV Push（會導致心跳停止）。必須稀釋、使用輸液泵嚴格控制速率、監測尿量（確保腎功能正常以排鉀）、並觀察血管注射部位是否有發炎或滲漏（因鉀離子具強烈刺激性）。
Potassium chloride must be diluted, administered via infusion pump to control rate, and given only if urine output is adequate to prevent hyperkalemia. Nurses must monitor the site for phlebitis because potassium is irritating, and IV push administration is strictly prohibited as it can cause fatal cardiac arrest.
✦ 台美臨床差異
美台皆將靜脈輸注鉀離子視為高警訊藥物（High-Alert Medication），作業流程高度一致。