✨ 精选课程 · 第8课，共8课 · 60 sec
绝不推注，绝不压碎，绝不夹闭
Never Push, Never Crush, Never Clamp
🚫 三个护理“绝不”，每一个都曾造成死亡。三道考试题，如果你知道它们，就是送分题。
🚫 Three nursing 'nevers' that each have a body count. Three exam questions that are gifts if you know them.
💡 核心要点
钾用泵输注，不推注。长效药片要整片吞下。胸管保持开放。
Potassium is pumped, not pushed. Long-acting pills are swallowed whole. Chest tubes stay open.
🧠 为什么重要
绝不IV推注钾，无论何种浓度；推注可能使心脏停跳。仅在稀释后、在输液泵上以规定的速度给予它（通常经外周导管不超过10 mEq/h）。绝不压碎缓释、持续释放或肠溶片（标签上的XL、ER、SR、EC、XR）；压碎会让本应持续整个给药间隔（通常12到24小时）的剂量一次性释放出来，或者破坏保护胃或药物的包衣。请药剂师提供速释剂型。绝不常规夹闭胸管；滞留的空气会积聚成张力性气胸。如果管路断开，把末端放入无菌水中；如果管子脱出，用一块三边贴胶布的封闭敷料覆盖孔口。
NEVER PUSH potassium IV, at any concentration; a push can stop the heart. Give it only diluted, on an infusion pump, at the prescribed rate (typically no more than 10 mEq/h through a peripheral line). NEVER CRUSH extended-release, sustained-release or enteric-coated tablets (XL, ER, SR, EC, XR on the label); crushing releases a dose meant to last the whole dosing interval (often 12 to 24 hours) all at once, or destroys the coating that protects the stomach or the drug. Ask the pharmacist for an immediate-release form. NEVER CLAMP a chest tube routinely; trapped air builds into a tension pneumothorax. If the tubing disconnects, put the end in sterile water; if the tube comes out, cover the hole with an occlusive dressing taped on three sides.
🏥 真实场景
💊 一位忙碌的护士把一位患者的缓释metoprolol压碎放进苹果酱里，以省去吞咽的困难。整个24小时的剂量一次性进入体内，心率降至38。标签上的字母“XL”就是全部警告。
💊 A busy nurse crushes a client's extended-release metoprolol into applesauce to save a swallowing struggle. The entire 24-hour dose lands at once and the heart rate falls to 38. The letters 'XL' on the label were the whole warning.
📌 要点总结
- 钾：绝不IV推注Potassium: never IV push
- XL、ER、SR、EC：绝不压碎XL, ER, SR, EC: never crush
- 胸管：绝不夹闭；断开时放无菌水，脱出时用三边敷料Chest tube: never clamp; sterile water if disconnected, three-sided dressing if dislodged
✅ 自我测试
一位使用饲管的患者被处方了一种缓释片，护士应怎么做？A client with a feeding tube is prescribed an extended-release tablet. What should the nurse do?
- 压得很细并充分冲洗Crush it finely and flush well
- 溶于温水Dissolve it in warm water
- 请药剂师提供速释剂型Ask the pharmacist for an immediate-release form
- 整片通过管子给药Give it whole through the tube
答案: C · 请药剂师提供速释剂型
缓释产品不能压碎或溶解；药剂师或处方者会提供替代剂型。
Extended-release products cannot be crushed or dissolved; the pharmacist or prescriber supplies an alternative formulation.
一位患者的胸管与引流系统断开，护士的即时措施是什么？A client's chest tube becomes disconnected from the drainage system. What is the nurse's immediate action?
- 在靠近胸部处夹闭管子Clamp the tube near the chest
- 重新连接脏的管路Reconnect the dirty tubing
- 拔除胸管Remove the chest tube
- 将开放末端放入无菌水中Place the open end in sterile water
答案: D · 将开放末端放入无菌水中
将开放末端浸入一容器无菌水中能形成水封，在更换系统期间防止空气进入；夹闭有导致张力性气胸的风险。
Submerging the open end in a container of sterile water creates a water seal that prevents air entry while the system is replaced; clamping risks tension pneumothorax.
在应用中练习 NCLEX 风格的题目，赚取 XP、保持连续天数，英文学习，中文辅助。无需注册。