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 woman at 28 weeks is Rh-negative and has a positive antibody screen for anti-D. What does this mean?
- AHer baby is definitely Rh-negative
- BShe needs a double dose of anti-D immunoglobulin
- CThe result is normal and needs no further action
- DShe is sensitised; the fetus is watched for anaemia
2.产科护理困难
A woman is 10 cm dilated with an urge to push. The fetal head is at station 0 and the tracing is normal. Which approach is supported by current practice?
- AAsk her to push continuously from 7 cm onwards
- BLet her push with her urge in a position she prefers
- CInsist she lies flat on her back and holds her breath for long periods
- DTell her not to push until the head is visible
3.剂量计算中等
需要从 10%（w/v）溶液中取 250 mg 的剂量。多少容量 V 含有这一剂量？
250 mg10% w/v
V = mL
4.剂量计算困难
一袋输液在 250 mL 中含 40000 单位药物。医嘱为每小时 2000 单位。泵速 R 应设为多少 mL/h？
40000 件/250 mL2000 件/h
R = mL/h
5.静脉输液速度中等
医嘱要求以 60 mL/h 输液，但没有输液泵。改用滴系数为 10 gtt/mL 的输液器重力滴注。求滴速 R，以每分钟滴数表示。
60 mL/h10 gtt/mL
R = gtt/min
6.静脉输液速度困难
医嘱要求在 10 小时内输入 1000 mL。4 小时后你发现袋中还剩 680 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？
1000 mL / 10 h经过 4 h: 680 mL
Δ = %
3溶液
1.产科护理
答案: D · She is sensitised; the fetus is watched for anaemia
为什么是这个答案
If antibodies are already present, anti-D prophylaxis is of no use. Antibody levels are followed and the fetus is monitored for anaemia, often with Doppler of the middle cerebral artery.
答案
D · She is sensitised; the fetus is watched for anaemia
2.产科护理
答案: B · Let her push with her urge in a position she prefers
为什么是这个答案
Spontaneous pushing with the urge, short breath holds and upright or side-lying positions are encouraged. Long, forced Valsalva pushing in the supine position can reduce placental blood flow.
答案
B · Let her push with her urge in a position she prefers
3.剂量计算
答案: V = 2.5 mL
Solution strengths: a percentage strength is grams per 100 mL, so 1% = 1 g/100 mL = 10 mg/mL. A ratio strength 1:1000 means 1 g in 1000 mL = 1 mg/mL; 1:10 000 is 0.1 mg/mL. For a dilution the amount of drug stays the same: C₁·V₁ = C₂·V₂.
浓度
10% = 100 mg/mL
体积
V = 250/100 = 2.5 mL
答案
V = 2.5 mL
4.剂量计算
答案: R = 12.5 mL/h
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。
浓度
40000/250 = 160 件/mL
泵速
R = 2000/160 = 12.5 mL/h
答案
R = 12.5 mL/h
5.静脉输液速度
答案: R = 10 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
60/60 = 1 mL/min
滴速
R = 1·10 = 10 gtt/min
答案
R = 10 gtt/min
6.静脉输液速度
答案: Δ = 13.33 %
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
1000/10 = 100 mL/h
新速率
R = 680/6 = 113.3 mL/h
变化百分比
Δ = (113.3 − 100)/100·100% = 13.33%
答案
Δ = 13.33%
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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