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 who has had a caesarean asks when she can drive again. Which answer is most accurate?
- AWhen she can brake hard without pain
- BNever before 6 months
- CThe same day she is discharged
- DOnly after her stitches are removed by a doctor
2.产科护理困难
A labouring woman has a temperature of 38.5 °C (101.3 °F), and the fetal baseline has risen from 140 to 170 bpm over the last hour. What is the most likely explanation?
- AFetal tachycardia due to a maternal opioid
- BReassuring fetal response to contractions
- CFetal head compression
- DFetal tachycardia due to maternal fever or infection
3.剂量计算中等
一名体重 8 kg 的儿童按 15 mg/kg 处方用药。原液浓度为 25 mg/mL。请抽取剂量：应给多少体积 V？
8 kg15 mg/kg25 mg/mL
V = mL
4.剂量计算困难
一名体重 28 kg 的儿童，医嘱为口服混悬液每次 10 mg/kg，该混悬液每 5 mL 含 125 mg。你应给多少体积 V？
28 kg10 mg/kg125 mg/5 mL
V = mL
5.静脉输液速度中等
医嘱要求以 30 mL/h 输液，但没有输液泵。改用滴系数为 60 gtt/mL 的输液器重力滴注。求滴速 R，以每分钟滴数表示。
30 mL/h60 gtt/mL
R = gtt/min
6.静脉输液速度困难
50 mg 药物溶于 500 mL 的输液以 6 mL/h 运行。患者每分钟接受多少微克 D？
50 mg/500 mL6 mL/h
D = mcg/min
3溶液
1.产科护理
答案: A · When she can brake hard without pain
为什么是这个答案
There is no fixed time. She can drive when she can brake suddenly, look over her shoulder and wear a seat belt comfortably. Many women need about 4 to 6 weeks, and insurance rules may apply.
答案
A · When she can brake hard without pain
2.产科护理
答案: D · Fetal tachycardia due to maternal fever or infection
为什么是这个答案
Maternal fever, often from intra-amniotic infection, is a common cause of fetal tachycardia. The provider is informed, and treatment of fever and infection is expected. Opioids reduce variability rather than raise the rate.
答案
D · Fetal tachycardia due to maternal fever or infection
3.剂量计算
答案: V = 4.8 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。
按体重计算剂量
D = 15·8 = 120 mg
体积
V = 120/25 = 4.8 mL
在注射器上
在这支 10 mL 的注射器上，每条小刻度线代表 0.2 mL。
答案
V = 4.8 mL
4.剂量计算
答案: V = 11.2 mL
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。
按体重计算剂量
10·28 = 280 mg
体积
V = (280/125)·5 = 11.2 mL
答案
V = 11.2 mL
5.静脉输液速度
答案: R = 30 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
30/60 = 0.5 mL/min
滴速
R = 0.5·60 = 30 gtt/min
答案
R = 30 gtt/min
使用微滴输液器（60 gtt/mL）时，gtt/min 等于 mL/h。
6.静脉输液速度
答案: D = 10 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/500 mL = 100 mcg/mL
每小时剂量
6·100 = 600 mcg/h
每分钟剂量
D = 600/60 = 10 mcg/min
答案
D = 10 mcg/min
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