# 一名罹患慢性阻塞性肺疾病(COPD)的67歲個案前來定期門診,免疫接種紀錄顯示未曾接種任何肺炎鏈球菌疫苗。今日針對肺炎鏈球菌預防,護理師最適當的建議為何? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=360522&lang=zh-tw > language: zh-TW > subject: Assignment/Delegation/Supervision > category: HPM ## 題目 一名罹患慢性阻塞性肺疾病(COPD)的67歲個案前來定期門診,免疫接種紀錄顯示未曾接種任何肺炎鏈球菌疫苗。今日針對肺炎鏈球菌預防,護理師最適當的建議為何? ## 選項 1. 延後所有肺炎鏈球菌疫苗至個案滿70歲,除非出現症狀 2. 今日先打PPSV23,並安排6個月後追加PCV15 3. 今日施打單劑PCV20;不需再追加任何肺炎鏈球菌疫苗 **✔ 正確答案** 4. 安排今日同一次門診同時接種PCV13與PPSV23 **正確答案: 3** ## 解析 選項 3 正確。先前未接種疫苗的 50 歲（含）以上成人可接種一劑 PCV20 或 PCV21，除非未來有基於風險的建議適用，否則即完成肺炎鏈球菌疫苗接種系列。COPD 進一步增加此個案的風險，因此不應延遲接種疫苗。選項 1 不正確，因為症狀和 70 歲都不是先決條件。選項 2 不正確，因為先接種 PPSV23 並在六個月後接種 PCV15 顛倒了先接種結合型疫苗的順序，且並非目前的優先建議時程。選項 4 不正確，因為 PCV13 和 PPSV23 不會同時接種，且對於先前未接種疫苗的成人，目前較高價數的結合型疫苗已取代該舊有方法。 ## 深入解析 Clinical Judgment 關鍵線索是未接種、免疫正常、65歲以上+COPD。Recognize Cues(侵襲性肺炎鏈球菌感染高風險)→Analyze Cues(ACIP 2024認可單劑PCV20為完整系列)→Take Action(今日接種PCV20,不需追加PPSV23)。 Memory Tip 「PCV20=一針搞定」—未接種65歲以上。若改用PCV15,免疫正常者PPSV23間隔須至少1年;免疫低下、CSF滲漏、人工耳蝸者為至少8週。 KR vs US 韓國:65歲以上於衛生所免費施打PPSV23 1劑。美國:ACIP 2024偏好PCV20單劑用於未接種65歲+;PCV13已不再是成人一線疫苗。 ## 臨床情境 Clinical Practice Guide ACIP 2024簡化—未接種、免疫正常65歲+成人可選 (a) 單劑PCV20,或 (b) PCV15後PPSV23(間隔至少1年)。單劑PCV20一次涵蓋主要侵襲血清型,提升年長者順從度。 Caution 嚴禁同次接種PCV與PPSV23。若選PCV15且為高風險(免疫低下、CSF滲漏、人工耳蝸),PPSV23間隔縮短為8週。需登錄批號、注射部位與同意書。 ## 重要概念 - **PCV20(20價肺炎鏈球菌結合型疫苗)** — 含20種血清型之肺炎鏈球菌結合型疫苗。ACIP建議用於未接種之65歲以上成人,或具風險因子之19~64歲成人,以單劑施打;涵蓋過去須追加PPSV23才能涵蓋的主要侵襲血清型。 - **PPSV23(23價肺炎鏈球菌多醣體疫苗)** — 含23種血清型之多醣體疫苗。於PCV15之後依排程接種—免疫正常65歲+間隔至少1年,高風險族群至少8週。與PCV不可在同次門診替換。 - **ACIP(Advisory Committee on Immunization Practices)** — 美國CDC旗下之疫苗建議諮詢委員會。其2024年成人肺炎鏈球菌指引新增以單劑PCV20作為65歲+未接種成人之完整接種系列。 - **Immunosenescence** — The age-related decline in immune function that increases susceptibility to infections like pneumococcal disease, supporting the rationale for earlier routine vaccination. - **PPSV23** — The 23-valent pneumococcal polysaccharide vaccine, which was previously used in series with PCV13 but is no longer needed after a single dose of PCV20 in most adults. ## 相同主題題目 - [A registered nurse on a medical-surgical unit is delegating tasks at the start of shift. W…](https://mymerci.kr/pages/nclex_q.php?qn_id=360523&lang=zh-tw) - [A client with newly diagnosed metastatic colon cancer is admitted to a medical-surgical un…](https://mymerci.kr/pages/nclex_q.php?qn_id=362185&lang=zh-tw) - [A 65-year-old female client received intravenous morphine 30 minutes ago for postoperative…](https://mymerci.kr/pages/nclex_q.php?qn_id=362206&lang=zh-tw) - [A 78-year-old male client with end-stage pancreatic cancer is enrolled in inpatient hospic…](https://mymerci.kr/pages/nclex_q.php?qn_id=362322&lang=zh-tw) - [A nurse on a medical-surgical unit is starting a 0700 round and reviews these four assigne…](https://mymerci.kr/pages/nclex_q.php?qn_id=362403&lang=zh-tw) - [An RN is assigning care on a medical-surgical unit to an LPN/VN and a trained unlicensed a…](https://mymerci.kr/pages/nclex_q.php?qn_id=362464&lang=zh-tw) - [A 63-year-old female is being discharged after a 14-day hospitalization following complex …](https://mymerci.kr/pages/nclex_q.php?qn_id=372685&lang=zh-tw) - [The charge nurse on a medical-surgical unit is assigning tasks for a licensed practical nu…](https://mymerci.kr/pages/nclex_q.php?qn_id=393555&lang=zh-tw) ## 以其他語言閱讀 - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=360522&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=360522&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=360522&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=360522&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=360522&lang=vi) --- More free questions: [NCLEX-RN 題庫](https://mymerci.kr/pages/nclex_bank.php?lang=zh-tw) _僅供學習參考。實際臨床請遵循最新指引與所屬機構規範。_