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24歲病人因右側脛骨中段閉鎖性骨折入院並於6小時前裝置玻璃纖維長腿石膏。護理師連續記錄右下肢神經血管評估。請檢視趨勢並回答問題。

Trend

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Time	Data
06:00 (cast applied)	Pain 4/10, distal pulses 2+, capillary refill <2s, sensation intact, motor intact, mild swelling expected疼痛 4/10，遠端脈搏 2+，微血管回填 <2 秒，感覺完整，運動完整，輕微腫脹屬預期
08:00	Pain 6/10 with hydromorphone, distal pulses 2+, capillary refill <2s, mild paresthesia of toes使用 hydromorphone 後疼痛 6/10，遠端脈搏 2+，微血管回填 <2 秒，腳趾輕微麻木
10:00	Pain 8/10 unrelieved by hydromorphone, calf firm and shiny, distal pulses 1+, capillary refill 3s, paresthesia of toes worseninghydromorphone 無法緩解疼痛 8/10，小腿緊硬且發亮，遠端脈搏 1+，微血管回填 3 秒，腳趾麻木加重
12:00	Pain 10/10, calf tense and pale, distal pulses faint, sensation diminished, unable to dorsiflex foot疼痛 10/10，小腿緊繃且蒼白，遠端脈搏微弱，感覺降低，無法背屈足部

Q1. What is the overall trend?整體趨勢為何？

Improving as expected如預期般改善 Stable with mild swelling伴隨輕微腫脹但穩定 Deteriorating — early acute compartment syndrome惡化中 — 早期急性腔室症候群

Q2. Which is the priority nursing action?優先的護理措施為何？

Re-medicate with PRN hydromorphone and reassess in 30 minutes再次給予 PRN hydromorphone，30 分鐘後重新評估 Bivalve or remove the cast at the bedside, keep extremity at heart level, and notify the orthopedic surgeon STAT在床邊將石膏雙側切開或移除，患肢維持在心臟高度，並立即通知骨科醫師 Elevate the extremity above heart level on pillows to reduce swelling將患肢墊高至心臟以上以減少腫脹 Document the findings and continue Q1H neurovascular checks記錄發現並持續每小時神經血管檢查

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