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
Which statement about the lactational amenorrhoea method (LAM) is correct?
- AIt needs full breastfeeding, no periods and a baby under 6 months
- BIt works for as long as the mother breastfeeds at all
- CIt becomes more reliable after the periods return
- DIt is reliable even when the baby is formula-fed at night
2.产科护理困难
A term newborn has rapid breathing at 2 hours after a caesarean without labour. Saturation is normal, there is no fever and the chest X-ray shows fluid in the fissures. What is the most likely diagnosis?
- ANeonatal pneumonia with sepsis
- BRespiratory distress syndrome of prematurity
- CMeconium aspiration syndrome
- DTransient tachypnoea of the newborn
3.剂量计算中等
一名体重 30 kg 的患者体表面积为 0.96 m²。医嘱为 20 mg/m²。求剂量 D，以 mg 表示。
30 kgBSA = 0.96 m²20 mg/m²
D = mg
4.剂量计算困难
一名患者体重 19.8 lb。医嘱为单次剂量 15 mg/kg，储备液为 1 mL 中含 100 mg。按 1 kg = 2.2 lb 计算，你应给予多少容量 V？ 保留一位小数。
19.8 lb15 mg/kg100 mg/1 mL1 kg = 2.2 lb
V = mL
5.静脉输液速度中等
医嘱要求以 200 mL/h 输液，但没有输液泵。改用滴系数为 15 gtt/mL 的输液器重力滴注。求滴速 R，以每分钟滴数表示。
200 mL/h15 gtt/mL
R = gtt/min
6.静脉输液速度困难
一组输液以 50 滴/分的速度经 20 滴/mL 的输液器滴注。袋中还剩 200 mL。还需多少小时 t 才会滴完？ 保留一位小数。
50 gtt/min20 gtt/mL200 mL
t = h
3溶液
1.产科护理
答案: A · It needs full breastfeeding, no periods and a baby under 6 months
为什么是这个答案
LAM is effective only if the mother is fully or nearly fully breastfeeding day and night, her periods have not returned and the baby is under 6 months. Ovulation can occur before the first period.
答案
A · It needs full breastfeeding, no periods and a baby under 6 months
2.产科护理
答案: D · Transient tachypnoea of the newborn
为什么是这个答案
Transient tachypnoea is common after caesarean birth without labour. Supportive care is usually enough, but infection must be considered if the baby becomes unwell or fails to improve.
答案
D · Transient tachypnoea of the newborn
3.剂量计算
答案: D = 19.2 mg
Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).
剂量
D = 20·0.96 = 19.2 mg
答案
D = 19.2 mg
4.剂量计算
答案: V = 1.4 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)
19.8/2.2 = 9 kg
剂量
15·9 = 135 mg
体积
V = (135/100)·1 = 1.35 ≈ 1.4 mL
答案
V = 1.4 mL
5.静脉输液速度
答案: R = 50 gtt/min
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.
每分钟毫升数
200/60 = 3.333 mL/min
滴速
R = 3.333·15 = 50 gtt/min
答案
R = 50 gtt/min
6.静脉输液速度
答案: t = 1.3 h
输注速率：输液泵按 mL/h = 体积/时间（小时）设定。重力滴注按每分钟滴数计：gtt/min = 体积 (mL) × 滴系数 (gtt/mL)/时间 (min)。 滴系数印在输液器包装上：普通输液器为 10、15 或 20 gtt/mL（输血器在美国常为 10 gtt/mL，在英国为 15），微量输液器为 60 gtt/mL。务必使用题目或包装给出的滴系数。
速度（mL/h）
50·60/20 = 150 mL/h
剩余时间
t = 200/150 = 1.333 ≈ 1.3 h
答案
t = 1.3 h
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