# 一位65歲患有第二型糖尿病的個案，因風濕性多肌痛症發作，開始每日口服prednisone 40毫克。護理師應指導個案在家中追蹤哪項監測參數，並向開立處方者報告？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375107&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一位65歲患有第二型糖尿病的個案，因風濕性多肌痛症發作，開始每日口服prednisone 40毫克。護理師應指導個案在家中追蹤哪項監測參數，並向開立處方者報告？

## 選項

1. 每日4次指尖血糖與微燒、倦怠、傷口癒合遲緩等感染徵象。 **✔ 正確答案**
2. 每日兩次監測血壓，以及任何體液過多的徵象，如腳踝腫脹、呼吸急促或體重迅速增加。
3. 每日兩次檢查指尖血糖，以及任何高血糖的徵象，如口渴增加、飢餓感或頻尿。
4. 監測眼壓升高的徵象，如視力模糊、眼痛或看到燈光周圍有光暈。

**正確答案: 1**

## 解析

全身性皮質類固醇會藉由增加肝臟糖質新生和周邊胰島素阻抗，引起類固醇誘發之高血糖。對於已有糖尿病的病人，血糖上升通常相當劇烈，需要更頻繁的指尖血糖監測（開始用藥期間常需每日四次），且可能需暫時增加胰島素或口服降血糖藥的劑量。類固醇也會抑制發燒和發炎反應，因此典型的感染徵象會被掩蓋：發燒可能輕微或無發燒，心搏過速和不適可能是唯一的線索，且傷口癒合延遲。應教導病人立即報告細微的感染徵象（喉嚨痛、排尿困難、任何傷口發紅或分泌物、持續疲勞、輕微發燒）。雖然血壓、眼科檢查和體重長期追蹤也很重要，但在開始用藥期間，立即的居家監測優先事項為血糖和感染監測。

## 深入解析

類固醇加糖尿病加感染易感為每日居家監測三大項。"感染徵象可能被掩蓋"是NCLEX教授非典型監測的關鍵語。

## 重要概念

- **steroid-induced hyperglycemia** — 肝糖質新生增加、周邊胰島素阻抗增、糖尿病患可能需更頻繁BG與劑量上調
- **masked infection** — 類固醇抑制發燒與發炎反應、輕微徵象(微燒、咽痛、排尿不適)需回報
- **delayed wound healing** — 抑制膠原合成與上皮再生、長期使用造成壓瘡或術後傷口癒合慢

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