# 末期心臟衰竭病人進入瀕死期，家屬在床邊。哪些護理介入支持舒適、有尊嚴之死亡？請選擇所有適用項目。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=373259&lang=zh-tw  
> language: zh-TW  
> subject: Basic Care and Comfort  
> category: BCC

## 題目

末期心臟衰竭病人進入瀕死期，家屬在床邊。哪些護理介入支持舒適、有尊嚴之死亡？請選擇所有適用項目。

1

即使病人意識喪失，仍以棉棒頻繁進行口腔護理並維持嘴唇/口腔黏膜濕潤以求舒適。

2

以側臥位並輕微抬高床頭以利分泌物以重力排出，而非積極深部抽吸。

3

使用深部口咽抽吸來清除分泌物，因為這可以減少對家屬而言困擾的「死亡哮吼」聲音。

4

鼓勵家屬與病人說話並接觸 — 一般認為終末期聽覺仍存在。

5

給予定時或PRN抗膽鹼藥(如glycopyrrolate、atropine)以減少上呼吸道分泌。

## 解析

終末期以舒適為優先。「Death rattle」是病人無法吞嚥造成上呼吸道分泌物積聚 — 對家屬比對病人更困擾，最佳處置為體位+抗分泌藥(glycopyrrolate、atropine、scopolamine)。頻繁口腔護理與家屬陪伴/接觸支持尊嚴。積極深部抽吸(3)不舒適、造成傷害且罕能改善rattle — 除非真有上呼吸道阻塞否則應避免。

## 深入解析

最常考之終末期衛教點為「death rattle不要深部抽吸」。家屬需被告知此呼吸型態與聲音不代表病人在受苦，且病人無感。舒適藥物(嗎啡治呼吸困難、glycopyrrolate治分泌物)既不加速死亡也不延緩。

## 臨床情境

**末期心臟衰竭瀕死期病人**於安寧照護。病人意識喪失、出現斑駁、不規則呼吸與可聞之上呼吸道分泌物("death rattle")。家屬在床邊。

## 重要概念

- **瀕死期** — 以斑駁、Cheyne-Stokes或不規則呼吸、尿量減少、意識喪失為特徵之最後數小時至數日。
- **Death rattle** — 瀕死病人無法吞嚥造成之可聞上呼吸道分泌物；以體位與抗膽鹼藥處置。
- **Glycopyrrolate / atropine** — 瀕死期減少唾液與支氣管分泌之抗膽鹼藥；為終末期分泌物之第一線。

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