# 一名70歲的個案長期接受digoxin治療，過去兩天新出現看燈光周圍有黃綠色光圈、食慾不振及異常疲倦。護理師應優先採取哪項措施？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374884&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名70歲的個案長期接受digoxin治療，過去兩天新出現看燈光周圍有黃綠色光圈、食慾不振及異常疲倦。護理師應優先採取哪項措施？

## 選項

1. 下一劑前鼓勵病人多吃香蕉以平衡電解質
2. 紀錄發現,改至下次例行門診時處理
3. 依排程給予下一劑,4小時後再評估
4. 暫停劑量、通報醫師,並抽血清digoxin濃度與基本代謝panel **✔ 正確答案**

**正確答案: 4**

## 解析

為何選項4正確
個案正報告經典的HALOS毒性：黃綠色視覺光圈（眼部）、食慾不振（食慾）及疲倦（嗜睡）。Digoxin具有狹窄的治療指數，因此任何令人擔憂的症狀都需要停藥、立即通知醫師，並檢測血清digoxin濃度及基礎代謝檢查組（鉀、鎂、肌酸酐）。

為何其他選項錯誤
選項3對可能已中毒的個案追加給藥，會加劇毒性。選項1（「多吃香蕉」）是零碎的家庭療法，無法處理可能的血清濃度問題，且延誤診斷。選項2僅記錄但拖延——毒性具時間敏感性，可能惡化為危及生命的心律不整。

## 深入解析

辨識HALOS
Headache、Anorexia、Lethargy、Ocular變化(黃綠色光暈、視野模糊或霧、畏光)、GI症狀(噁心、嘔吐、腹痛、腹瀉)。視覺相關主訴尤具特徵。

為何濃度與電解質須同時抽
低K(K 10 ng/mL、致命性心律不整、急性中毒hyperkalemia >5)時用digoxin immune Fab(Digibind)。

## 臨床情境

臨床情境
病人於心臟科門診回診。掛號時主動向醫療助理表示「燈周圍有奇怪光暈」。

## 重要概念

- **HALOS toxicity首字** — Headache、Anorexia、Lethargy、Ocular變化(黃綠光暈、視野模糊)、GI症狀(噁心、嘔吐、腹瀉)。視覺變化高度特異於digoxin toxicity。
- **為何HOLD + 濃度 + BMP** — 停藥、抽blood digoxin濃度(治療0.5-2 ng/mL)與基本代謝panel(K、Mg、creatinine)。低K或腎功能不良可解釋治療濃度下發生之toxicity。
- **Digoxin immune Fab (Digibind) 適應症** — 嚴重toxicity:慢性中毒濃度>10 ng/mL、致命性心律不整(Vfib、持續性Vtach、完全房室阻滯、atropine無效之嚴重緩脈)、急性過量伴hyperkalemia >5、成人攝食>10 mg或兒童>4 mg。

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