# 一名使用budesonide turbuhaler的個案主訴舌頭和口腔內側出現白色斑塊，且容易刮除。護理師最適當的行動為何？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391775&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名使用budesonide turbuhaler的個案主訴舌頭和口腔內側出現白色斑塊，且容易刮除。護理師最適當的行動為何？

## 選項

1. 在口腔塗抹hydrocortisone cream
2. 通知處方者；可能是ICS沉積造成的口腔念珠菌，可能會開立局部nystatin，並加強漱口吐掉技巧 **✔ 正確答案**
3. 安撫病人這是正常現象
4. 停止所有藥物直到斑塊消失

**正確答案: 2**

## 解析

正確答案 (2)：使用吸入型皮質類固醇的個案，舌頭與口腔黏膜出現可刮除的白色斑塊，即為口咽念珠菌感染。局部抗真菌藥物（例如 nystatin 口服懸液，以一天四次含漱後吞服的方式使用，持續7至14天）通常可治療此情況。應加強衛教個案在每次使用吸入型皮質類固醇後漱口吐出，並於使用定量吸入器時搭配吸藥輔助器。 (1) 這不是正常現象。 (3) 停用吸入型皮質類固醇會增加氣喘控制不良的風險。 (4) 局部類固醇會使念珠菌感染更嚴重。

## 深入解析

Memory Tip ICS thrush = 白色、可擦掉、潮濕。需與leukoplakia區分，後者不可刮除且可能為癌前病變。

## 臨床情境

Scenario 56歲男性使用budesonide DPI 4個月，舌頭/頰黏膜出現可刮除白色斑塊，輕微不適，無發燒或全身症狀。

## 重要概念

- **口腔念珠菌（鵝口瘡）** — 可刮除的白色黴菌斑塊；ICS常見副作用。
- **Nystatin口服懸液** — 局部抗黴菌藥，含漱後吞服QID；ICS相關鵝口瘡第一線。
- **漱口吐掉預防** — ICS標準衛教；降低但不能完全消除鵝口瘡風險。

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