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
When the Moro reflex is tested, the baby moves only one arm. What could this suggest?
- AA clavicle fracture or nerve injury
- BLow blood glucose only
- CHearing loss in the ear on that side
- DA normal finding in all term babies
2.产科护理困难
Which statement by a pregnant woman with gestational diabetes shows she understands her care?
- A"I can skip meals if my glucose is high in the morning."
- B"My baby's growth will not need monitoring."
- C"I will check my glucose as shown and record it."
- D"Insulin will harm my baby, so I will refuse it."
3.剂量计算中等
一名体重 54 kg 的患者体表面积为 1.41 m²。医嘱为 135 mg/m²。求剂量 D，以 mg 表示。
54 kgBSA = 1.41 m²135 mg/m²
D = mg
4.剂量计算困难
处方剂量为 740 微克。安瓿浓度为 2 mg/mL。请用 1 mL 注射器抽取剂量：应给多少体积 V？
740 mcg2 mg/mL
V = mL
5.静脉输液速度中等
医嘱要求以 150 mL/h 输液，但没有输液泵。改用滴系数为 20 gtt/mL 的输液器重力滴注。求滴速 R，以每分钟滴数表示。
150 mL/h20 gtt/mL
R = gtt/min
6.静脉输液速度困难
50 mg 药物溶于 250 mL 的输液以 18 mL/h 运行。患者每分钟接受多少微克 D？
50 mg/250 mL18 mL/h
D = mcg/min
3溶液
1.产科护理
答案: A · A clavicle fracture or nerve injury
为什么是这个答案
The Moro reflex should be bilateral and symmetrical. An absent response on one side suggests clavicle fracture or brachial plexus palsy, both linked with shoulder dystocia and large babies.
答案
A · A clavicle fracture or nerve injury
2.产科护理
答案: C · "I will check my glucose as shown and record it."
为什么是这个答案
Regular glucose monitoring with records guides treatment changes. Skipping meals can cause hypoglycaemia and ketosis, insulin does not cross the placenta in a meaningful amount, and fetal growth is monitored.
答案
C · "I will check my glucose as shown and record it."
3.剂量计算
答案: D = 190.3 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 = 135·1.41 = 190.3 mg
答案
D = 190.3 mg
4.剂量计算
答案: V = 0.37 mL
抽取剂量：体积 = (处方剂量/药物浓度) × 药物体积。先换算成相同的单位，再检查该体积是否适合注射器，并落在它的某一个刻度上。
单位相同
2 mg/mL = 2000 mcg/mL
体积
V = 740/2000 = 0.37 mL
答案
V = 0.37 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
150/60 = 2.5 mL/min
滴速
R = 2.5·20 = 50 gtt/min
答案
R = 50 gtt/min
6.静脉输液速度
答案: D = 60 mcg/min
Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).
浓度
50000 mcg/250 mL = 200 mcg/mL
每小时剂量
18·200 = 3600 mcg/h
每分钟剂量
D = 3600/60 = 60 mcg/min
答案
D = 60 mcg/min
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