# 情境 護理師接到術後嚴重疼痛hydromorphone 1 mg IV q4h prn醫囑。藥局送來標示hydromorphone 4 mg/mL的預充式針筒。給藥前優先護理為何?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375157&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PA

## 題目

情境 護理師接到術後嚴重疼痛hydromorphone 1 mg IV q4h prn醫囑。藥局送來標示hydromorphone 4 mg/mL的預充式針筒。給藥前優先護理為何?

## 選項

1. 使用等效止痛劑量表轉換劑量，確定 1 mg hydromorphone 相當於 7 mg morphine，從庫存中取得該劑量的 morphine，並以此代替 hydromorphone 給藥，以避免操作高濃度的預充式注射器。
2. 將整支預充式注射器作為藥品廢棄物丟棄，通知藥局現有的濃度對醫囑劑量不安全，並等待更換為較低濃度如 1 mg/mL 的注射器，以防止潛在的給藥錯誤。
3. 從預充式注射器中給予全部 1 mL 體積，因為醫囑為 1 mg，且注射器標籤為 1 mL，因此當濃度為 1 mg/mL 時，全部內容物符合醫囑劑量，此為 hydromorphone 的標準濃度。
4. 辨識為高警訊不符；不可按預充劑量直接給予；另用一支針筒抽出0.25 mL(1 mg)，剩下0.75 mL與見證者一同丟棄；與另一位護理師雙人核對劑量；記錄丟棄量。 **✔ 正確答案**

**正確答案: 4**

## 解析

Hydromorphone (Dilaudid)在IV時力價約為morphine的7倍 (1 mg IV hydromorphone ≒ 7 mg IV morphine)。因常與morphine劑量混淆且致命，所有高警訊藥物清單均列入。ISMP與Joint Commission標準：(1) 確認醫囑、適應症、病人、鴉片類耐受度；(2) 4 mg/mL針筒對1 mg醫囑相當於4個劑量 — 不可整支給予；(3) 抽出醫囑量0.25 mL (1 mg)至另一支針筒，剩餘量於有執照見證者下丟棄並記錄；(4) 多數機構建議高警訊IV鴉片類於給藥前由兩位護理師獨立雙人核對；(5) IV緩慢給予2~3分鐘；(6) 給藥前中後評估疼痛、鎮靜層級(POSS)、RR、SpO2；(7) 單次1 mg renarcotization少見，但累積劑量需持續監測。丟棄並等藥局會延誤止痛。未經醫囑換成morphine並不安全。整管4 mg投予將造成致命錯誤。

## 深入解析

高警訊辨識加見證丟棄加雙人核對是安全路徑。Hydromorphone不是morphine — 不可假設等效，不可面值投予預充針筒。

## 重要概念

- **hydromorphone potency** — IV 1 mg ≒ morphine 7 mg，高警訊，劑量混淆致命，需查等效表
- **witnessed waste** — 管制藥銷毀需有執照見證者，並記錄，符合DEA規定
- **two-nurse double check** — 高警訊藥物給藥前的獨立雙人核對：計算、標示、病人確認

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