# 護理師於甲狀腺全切除術後6小時評估病人。需立即通報醫師之發現?複選。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375018&lang=zh-tw  
> language: zh-TW  
> subject: Psychosocial Integrity  
> category: PSI

## 題目

護理師於甲狀腺全切除術後6小時評估病人。需立即通報醫師之發現?複選。

1

Chvostek與Trousseau陽性合併口周麻木

2

輕微切口疼痛經醫囑acetaminophen緩解

3

超出敷料之頸部腫脹合併喘鳴

4

突發體溫39.8°C合併HR 152、躁動

5

拔管後完全無法發聲或低語

## 解析

甲狀腺術後急症:(1)壓迫氣道之頸部血腫 — 可見腫脹與喘鳴,須床邊打開傷口排出血液。(2)副甲狀腺損傷致低鈣抽搐 — Chvostek/Trousseau陽性合併口周麻木需IV calcium gluconate。(3)雙側喉返神經損傷致完全失聲與氣道阻塞風險;單側為聲音沙啞。(4)甲狀腺風暴於充分準備之病人罕見,但高燒與心跳快需緊急處置。輕微切口痛經止痛藥緩解為預期。

## 深入解析

床邊急救盤:氣切包與拆線包。氣道未失之前打開傷口排血腫。

## 臨床情境

甲狀腺切除術後。術前鈣正常。拔管後聲音略沙啞但持續改善。

## 重要概念

- **Chvostek徵象** — 叩擊顏面神經處臉部痙攣 — 低鈣徵象。
- **Trousseau徵象** — 以血壓臂帶於收縮壓上3分鐘出現手腕痙攣 — 低鈣。
- **喉返神經** — 迷走神經分支支配聲帶內收 — 損傷致嘶啞或失聲。

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