# 一位60歲的個案因嚴重氣喘長期每日服用prednisone 10毫克，致電診所主訴有流感、發燒39°C、今日嘔吐兩次，且無法經口攝取液體。護理師最適當的回應為何？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375101&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一位60歲的個案因嚴重氣喘長期每日服用prednisone 10毫克，致電診所主訴有流感、發燒39°C、今日嘔吐兩次，且無法經口攝取液體。護理師最適當的回應為何？

## 選項

1. 「您可以在家休息並小口含冰塊來處理；如果24小時後仍無法喝下任何液體，請回電。」
2. 「口服30毫克prednisone（您每日劑量的三倍）並休息，以預防腎上腺功能不全；若持續嘔吐請來電。」
3. 請來院評估，可能需IV或IM hydrocortisone壓力劑量、IV輸液與止吐藥以預防腎上腺危機。 **✔ 正確答案**
4. 「因為您正在嘔吐，您應該跳過今天的prednisone；類固醇可能會增加胃部刺激，並延緩您從此疾病中恢復。」

**正確答案: 3**

## 解析

長期使用皮質類固醇的病人，因下視丘-腦垂體-腎上腺軸（HPA axis）受抑制，遇到生理壓力（如疾病、手術、創傷）時無法產生正常的皮質醇反應。標準的生病日規則為，輕微疾病期間將每日口服劑量加倍或增至三倍；但若病人因嘔吐或腹瀉無法口服藥物，則需注射hydrocortisone（50至100毫克靜脈或肌肉注射），以防止腎上腺危象發生。跳過劑量、等待24小時，或囑咐病人在家嘔吐時加倍用藥，都可能演變成危象：低血壓、低血容量、低血糖、高血鉀、低血鈉及休克。護理師應指示病人前來就診，接受注射型類固醇、靜脈輸液復甦、止吐劑，並評估潛在疾病。病人也應知道，接受手術、嚴重創傷，或任何持續無法口服藥物的情況，都需尋求醫療照護。

## 深入解析

嘔吐加慢性類固醇加急性病為非經腸壓力劑量的教科書適應症。選擇非經腸hydrocortisone優於PO是優先藥理決策。

## 重要概念

- **stress dose** — 生病、手術、創傷時為長期類固醇病人額外補充的皮質醇劑量
- **hydrocortisone 50-100 mg IV/IM** — 非經腸類固醇，於嘔吐、禁食、重症時使用，預防腎上腺危機
- **adrenal crisis** — 腎上腺危機、低血壓、低血糖、高鉀、低鈉、休克，須立即IV類固醇加輸液

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