产科护理
方法
- 把产妇放在时间轴上定位：孕周、产程阶段或产后第几天，再判断此时什么是正常的。
- 找出处于危险中的对象：母亲、胎儿或新生儿，或者其中不止一个。
- 把发现与其原因联系起来：减速用 VEAL CHOP，出血用四个 T，产后用 BUBBLE-HE。
- 优先选择改善血流和氧合的措施（侧卧、停用缩宫素、宫底按摩），然后再升级处理。
产科护理：速成包
公式表、每个专题的关键方法步骤和 6 道练习题，完整解答附在最后。
1公式与方法
剂量计算
- 由浓度计算剂量
- 体积 = 剂量 / 浓度
- 按体重给药
- 剂量 = mg/kg × 体重
- 片剂
- 片数 = 剂量 / 每片规格
- 单位
- 1 g = 1000 mg, 1 mg = 1000 mcg
方法
- 把医嘱剂量和药品规格换算为同一单位。
- 用“需要量除以现有量再乘以数量”：(D/H) × Q。
- 按体重给药时，先乘以以 kg 计的体重，再用日剂量除以给药次数。
- 先估算，再检查答案是否合理。
静脉输液速度
- 泵速
- mL/h = volume (mL)/time (h)
- 滴速
- drops/min = volume (mL) × drop factor / time (min)
- 输注时间
- time (h) = volume (mL)/rate (mL/h)
方法
- 泵速 mL/h：体积除以以小时计的时间。
- 滴速 drops/min：体积 × 滴系数，再除以以分钟计的时间。
- 剩余时间：剩余体积除以速率。
- 按题目或设备的要求取整。
2练习题
1.产科护理中等
A newborn has a cleft lip and palate. Which feeding approach is most appropriate?
- AFeeding lying flat on the back
- BFeeding only with a spoon from birth
- CWithholding feeds until surgery
- DSpecial teats and an upright position
2.产科护理困难
A large for gestational age newborn of a mother with diabetes is also very red and has a high haematocrit. Which complication of this finding should the nurse watch for?
- ADehydration caused by vomiting
- BHypothermia caused by sweating
- CJaundice
- DNeural tube defects
3.剂量计算中等
某患者体重 18 kg。医嘱剂量为每天 20 mg/kg，分 4 次等量给药。每次给多少毫克 D？
18 kg20 mg/kg/天4× 每天
D = mg
4.剂量计算困难
一名患者体重 145.2 lb。医嘱为单次剂量 15 mg/kg，储备液为 5 mL 中含 200 mg。按 1 kg = 2.2 lb 计算，你应给予多少容量 V？ 保留一位小数。
145.2 lb15 mg/kg200 mg/5 mL1 kg = 2.2 lb
V = mL
5.静脉输液速度中等
医嘱要求在 12 小时内输入 500 mL。9 小时后你发现袋中还剩 150 mL，而输液仍须按时完成。 必须把泵重新设定为多少 mL/h 的速率 R？
500 mL / 12 h经过 9 h: 150 mL
R = mL/h
6.静脉输液速度困难
医嘱要求在 8 小时内输入 1500 mL。4 小时后你发现袋中还剩 870 mL，而输液仍须按时完成。 原来的泵速必须提高百分之多少 Δ？
1500 mL / 8 h经过 4 h: 870 mL
Δ = %
3溶液
1.产科护理
答案: D · Special teats and an upright position
为什么是这个答案
Babies with a cleft palate often need specialised bottles or teats, an upright feeding position, frequent burping and support from a cleft team. Some babies with a cleft lip only can breastfeed.
答案
D · Special teats and an upright position
2.产科护理
答案: C · Jaundice
为什么是这个答案
Polycythaemia is common in infants of diabetic mothers and SGA babies. Breakdown of the extra red cells raises bilirubin, and high viscosity can cause poor feeding, lethargy or thrombosis.
答案
C · Jaundice
3.剂量计算
答案: D = 90 mg
剂量计算：给药量等于医嘱剂量除以现有药物的规格，再乘以该规格对应的量：给药量 = (医嘱剂量/储备规格) × 储备体积。始终统一单位（先把 g 换成 mg，mg 换成 mcg），并检查答案是否合理。
每日总量
20·18 = 360 mg
每次剂量
D = 360/4 = 90 mg
答案
D = 90 mg
4.剂量计算
答案: V = 24.8 mL
Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.
体重 (kg)
145.2/2.2 = 66 kg
剂量
15·66 = 990 mg
体积
V = (990/200)·5 = 24.75 ≈ 24.8 mL
答案
V = 24.8 mL
5.静脉输液速度
答案: R = 50 mL/h
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
原速率
500/12 = 41.67 mL/h
新速率
R = 150/3 = 50 mL/h
答案
R = 50 mL/h
许多医院允许在不重开医嘱的情况下进行不超过 25% 的此类调整；请查阅本院规定。
6.静脉输液速度
答案: Δ = 16 %
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
原速率
1500/8 = 187.5 mL/h
新速率
R = 870/4 = 217.5 mL/h
变化百分比
Δ = (217.5 − 187.5)/187.5·100% = 16%
答案
Δ = 16%
许多医院允许在不重开医嘱的情况下进行不超过 25% 的此类调整；请查阅本院规定。
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