# 急診護理師檢視病歷。哪些發現需要立即追蹤？請標示支持可能腎上腺危象的發現。 > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=568935&lang=zh-tw > language: zh-TW > subject: Medical Emergencies > category: PA ## 題目 急診護理師檢視病歷。哪些發現需要立即追蹤？請標示支持可能腎上腺危象的發現。 護理紀錄 1025: 個案由配偶陪同，自行開車從家中抵達。個案因發燒與腸胃道疾病兩天被送至急診。個案過去八個月因自體免疫疾病每日服用prednisone。配偶表示個案三天前因處方藥瓶已空而停止服用prednisone。個案從昨晚起已嘔吐六次，且無法留住液體或藥物。上個月門診記錄有慢性疲勞與漸進性體重減輕，無急性變化。皮膚在舊疤痕上有穩定變黑，已存在數月且近期無變化。抵達時，血壓為78/44 mm Hg，周邊脈搏微弱。脈搏每分鐘126次，呼吸每分鐘24次，室內空氣下血氧飽和度96%。個案回答緩慢，主訴全身無力。定點檢測顯示血糖值52 mg/dL。腹部輕微壓痛，無僵硬、反彈痛或肌衛。檢驗結果顯示血鈉124 mEq/L，血鉀5.9 mEq/L。配偶表示今早有一次稀便。護理師將個案置於持續監測，建立靜脈通路，並通知急診醫師。 ## 解析 類固醇突然中斷、持續嘔吐、嚴重低血壓、低血糖、低血鈉與高血鉀構成危及生命的腎上腺危象模式。緊急評估後，預期會給予快速皮質類固醇與輸液治療。 ## 深入解析 快速解答 危險的模式是長期使用prednisone中斷、反覆嘔吐、血壓78/44 mm Hg、血糖52 mg/dL、血鈉124 mEq/L與血鉀5.9 mEq/L。這些線索支持可能的腎上腺危象。 為什麼這是正確的 生病時，身體需要更多皮質醇。腎上腺受抑制的個案若無法服用替代類固醇，可能出現低血壓、低血糖、低血鈉與高血鉀。[1]立即治療包括靜脈注射皮質類固醇與生理食鹽水，常合併葡萄糖。[2] 簡單比喻或心智圖像 將皮質醇想像成緊急備用發電機。感染提高需求，同時燃料供應被切斷，因此循環與葡萄糖支持失效。此比喻解釋時間點，而非每個檢驗值的確切原因。 記憶掛鉤 類固醇停用加上壓力：血壓、血糖與血鈉下降；血鉀上升。 NCLEX 決策規則 當疾病或嘔吐中斷長期糖皮質激素，且出現類休克表現時，要想到腎上腺危象；檢查循環與血糖，同時準備緊急類固醇與輸液治療。 為什麼其他選項是錯的 慢性疲勞、漸進性體重減輕、穩定的皮膚變黑、輕微腹部壓痛與正常血氧飽和度可能出現在背景中。它們不像所選線索那樣強烈解釋突發的循環與代謝崩潰。參考文獻 - [1]NIDDK: Adrenal Insufficiency Definition and FactsNational Institute of Diabetes and Digestive and Kidney Diseases - [2]NIDDK: Treatment for Adrenal InsufficiencyNational Institute of Diabetes and Digestive and Kidney Diseases ## 相同主題題目 - [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=zh-tw) - [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=zh-tw) - [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=zh-tw) - [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=zh-tw) - [A 68-year-old client is admitted to the emergency department with suspected sepsis from a …](https://mymerci.kr/pages/nclex_q.php?qn_id=363987&lang=zh-tw) - [A nurse is caring for an adult client in the emergency department who is suspected to have…](https://mymerci.kr/pages/nclex_q.php?qn_id=363993&lang=zh-tw) - [A nurse is teaching a 72-year-old client with chronic heart failure (reduced ejection frac…](https://mymerci.kr/pages/nclex_q.php?qn_id=366202&lang=zh-tw) - [A nurse is caring for an adult client admitted with diabetic ketoacidosis. Laboratory resu…](https://mymerci.kr/pages/nclex_q.php?qn_id=366294&lang=zh-tw) ## 以其他語言閱讀 - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=568935&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=568935&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=568935&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=568935&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=568935&lang=vi) --- More free questions: [NCLEX-RN 題庫](https://mymerci.kr/pages/nclex_bank.php?lang=zh-tw) _僅供學習參考。實際臨床請遵循最新指引與所屬機構規範。_