# 一位正在接受派姆單抗治療的病人報告頻繁水樣便，超出其基礎水平。請根據每個發現所支持的決策進行分類。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522095&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

一位正在接受派姆單抗治療的病人報告頻繁水樣便，超出其基礎水平。請根據每個發現所支持的決策進行分類。

|  | 免疫介導性結腸炎線索 | 體液流失線索 | 需要立即升級至治療團隊 |
| --- | --- | --- | --- |
| 過去 24 小時內頻繁水樣便，超出基礎水平 |  |  |  |
| 新發絞痛性腹痛 |  |  |  |
| 黏膜乾燥，心率 112 次/分 |  |  |  |
| 肌酸酐從 0.8 增加到 1.4 毫克/分升 |  |  |  |
| 腹瀉在派姆單抗治療後開始 |  |  |  |
| 口服補水後排出成形糞便 |  |  |  |

## 解析

新發的頻繁腹瀉和腹痛提示免疫介導性結腸炎；黏膜乾燥、心動過速和肌酸酐升高顯示體液流失；這種模式需要及時的腫瘤科評估，而非單獨的自我治療。

## 深入解析

快速解答
連結免疫毒性、灌注影響和升級處理。

為何這是正確的
免疫介導性結腸炎可能在檢查點抑制劑治療期間或之後發生，並可能根據嚴重程度需要暫停治療、診斷評估和皮質類固醇治療。

簡單類比或心像
將用藥安全視為呼吸道檢傷分類：識別威脅、中斷暴露、支持生理功能並確認持久反應。

記憶點
線索、風險、行動、反應、復發檢查。

NCLEX 決策規則
選擇能預防最即時藥物相關危害的行動，同時保留重新評估和升級的空間。

為何其他選項是錯誤的
使惡化正常化、增加相互作用藥物或延遲急救的選項會使安全循環中斷。References
1DailyMed: KEYTRUDA (pembrolizumab)免疫介導性結腸炎、腹瀉評估、治療中斷和皮質類固醇管理

## 臨床情境

用藥安全審查
核實適應症、當前評估、呼吸和神經系統狀態、藥物交互作用、授權的急救措施和可衡量的後續追蹤。

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