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 32 weeks has varicose veins in her legs. Which advice is most appropriate?
- ASit with her legs crossed to support the veins
- BRaise the legs when resting and avoid long standing
- CWear tight elastic bands around the top of the thighs
- DAvoid walking until after the birth
2.产科护理困难
A woman at 8 weeks takes valproate for epilepsy. She asks whether she should stop it. Which response is best?
- AHalve the dose herself to reduce the risk to the baby
- BDo not stop it suddenly; arrange urgent specialist review
- CContinue as usual because epilepsy drugs are all safe in pregnancy
- DStop the drug today because it causes birth defects
3.剂量计算中等
某患者体重 22 kg。医嘱剂量为每天 2 mg/kg，分 4 次等量给药。每次给多少毫克 D？
22 kg2 mg/kg/天4× 每天
D = mg
4.剂量计算困难
你需要用 20%（w/v）储备液配制 250 mL 0.5%（w/v）溶液。 必须向储备液中加入多少水 W？
C₁ = 20%C₂ = 0.5%V₂ = 250 mL
W = mL
5.静脉输液速度中等
滴注以 40 gtt/min 的速度通过滴系数为 20 gtt/mL 的输液器。患者在 2 小时内接受多少毫升 V？
40 gtt/min20 gtt/mL2 h
V = mL
6.静脉输液速度困难
25 mg 药物溶于 250 mL 的输液以 30 mL/h 运行。患者每分钟接受多少微克 D？
25 mg/250 mL30 mL/h
D = mcg/min
3溶液
1.产科护理
答案: B · Raise the legs when resting and avoid long standing
为什么是这个答案
Leg elevation, regular walking, avoiding long standing and graduated compression stockings improve venous return. Crossing the legs and tight bands at the thigh restrict venous flow.
答案
B · Raise the legs when resting and avoid long standing
2.产科护理
答案: B · Do not stop it suddenly; arrange urgent specialist review
为什么是这个答案
Valproate is strongly teratogenic, but stopping antiepileptics suddenly can cause seizures that harm mother and fetus. She needs urgent specialist review to change treatment safely, ideally before conception.
答案
B · Do not stop it suddenly; arrange urgent specialist review
3.剂量计算
答案: D = 11 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
2·22 = 44 mg
每次剂量
D = 44/4 = 11 mg
答案
D = 11 mg
4.剂量计算
答案: W = 243.8 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.
储备液的容量
V₁ = 0.5·250/20 = 6.25 mL
需加水量
W = 250 − 6.25 = 243.8 mL
答案
W = 243.8 mL
5.静脉输液速度
答案: V = 240 mL
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.
速度（mL/h）
40·60/20 = 120 mL/h
体积
V = 120·2 = 240 mL
答案
V = 240 mL
6.静脉输液速度
答案: D = 50 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
25000 mcg/250 mL = 100 mcg/mL
每小时剂量
30·100 = 3000 mcg/h
每分钟剂量
D = 3000/60 = 50 mcg/min
答案
D = 50 mcg/min
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