# 84歲因肺炎住院,急性意識混亂、注意力波動、CAM陽性。安靜但注意力差(低活動性譫妄)。優先處置?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375129&lang=zh-tw  
> language: zh-TW  
> subject: NCLEX-RN  
> category: ROR

## 題目

84歲因肺炎住院,急性意識混亂、注意力波動、CAM陽性。安靜但注意力差(低活動性譫妄)。優先處置?

## 選項

1. 找出並處理可逆原因 — 檢視並停用抗膽鹼藥、治療肺炎、移除非必要尿管 **✔ 正確答案**
2. 對低活動性譫妄全天候給予haloperidol
3. 使用軟性約束以防自傷
4. 立即下一步做腦MRI

**正確答案: 1**

## 解析

譫妄管理基礎為非藥物與處理可逆原因:停用高風險藥物(抗膽鹼diphenhydramine、oxybutynin、鎮靜zolpidem、多巴胺拮抗reglan)、治療感染(此處肺炎)、移除非必要tether(Foley也促譫妄)、重新定向、活動、睡眠衛生。抗精神病藥非常規 — 僅在嚴重躁動危及自他、非藥物無效時短期低劑量,並避免用於純粹低活動性譫妄。約束惡化譫妄。MRI針對局部徵象,當有明確醫學誘因時非初步步驟。

## 深入解析

低活動性譫妄死亡率較高且易漏診。用驗證工具(CAM、CAM-ICU、4AT)。≥65歲入院應常規篩檢。

## 臨床情境

居家用藥:reglan、oxybutynin、zolpidem、diphenhydramine。睡眠不佳。已置Foley。

## 重要概念

- **譫妄** — 急性波動性注意/認知障礙 — 醫學急症。
- **CAM** — Confusion Assessment Method — 已驗證之譫妄篩檢。
- **Deprescribing** — 系統性減用引起或惡化譫妄之藥物。

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