— 生理適應 · HARD · MCQ —
一位 COPD 病患接受 4 L/min 氧氣，護理師發現病人變得嗜睡且呼吸頻率下降。最適當的行動為何？
A client with COPD is receiving oxygen at 4 L/min. The nurse notes the client is becoming lethargic and respiratory rate has decreased. What is the most appropriate action?
- ACall the rapid response team呼叫快速反應小組
- BIncrease the oxygen flow to 6 L/min將氧氣流量增加至 6 L/min
- CLower the oxygen flow and assess the client✓ 正解降低氧氣流量並評估個案
- DDocument the findings and continue monitoring記錄發現並繼續監測
— Explanation · 中文詳解 —
COPD 病人嗜睡且呼吸減慢是高碳酸血症或過度氧氣治療的徵兆。高流量氧氣抑制了病人的缺氧呼吸驅動。護理師應先降低氧氣濃度（恢復低流量），並密切監測呼吸狀況，必要時通知醫師。B 會加重二氧化碳堆積；D 則會延誤急救。
Lethargy and a decreased respiratory rate in a client with COPD indicate hypercapnia resulting from oxygen-induced suppression of the hypoxic drive. The nurse should immediately lower the oxygen flow rate to restore the client's respiratory drive and assess their status. Increasing oxygen or ignoring the symptoms could lead to severe respiratory depression and failure.
✦ 台美臨床差異
美國護理師對 Oxygen weaning 較有自主權，台灣則常需醫師確認後調整，但在緊急狀態下護理師應先行介入。