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 factor most increases a postnatal woman's risk of venous thromboembolism?
- AEarly walking after birth
- BCaesarean birth
- CNormal blood loss
- DBreastfeeding
2.产科护理困难
A woman at 26 weeks receiving terbutaline for preterm contractions has a heart rate of 132/min and chest tightness. What should the nurse do?
- AIncrease her IV fluids rapidly to lower her heart rate
- BWithhold the next dose and report the findings
- CGive the next dose early to stop contractions
- DReassure her that this is expected and continue
3.剂量计算中等
某患者体重 90 kg，医嘱为单次给药 5 mg/kg。求剂量 D（mg）。
90 kg5 mg/kg
D = mg
4.剂量计算困难
一名患者身高 134 cm，体重 38 kg。医嘱为 250 mg/m²。用 Mosteller 公式 BSA = √(身高 (cm) × 体重 (kg)/3600) 求剂量 D，以 mg 表示。
134 cm38 kg250 mg/m²
D = mg
5.静脉输液速度中等
滴注以 30 gtt/min 的速度通过滴系数为 60 gtt/mL 的输液器。患者在 12 小时内接受多少毫升 V？
30 gtt/min60 gtt/mL12 h
V = mL
6.静脉输液速度困难
医嘱要求在 12 小时内输入 500 mL。9 小时后你发现袋中还剩 150 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？
500 mL / 12 h经过 9 h: 150 mL
Δ = %
3溶液
1.产科护理
答案: B · Caesarean birth
为什么是这个答案
Pregnancy and the postpartum period are hypercoagulable. Caesarean birth, immobility, obesity, older age and previous VTE add to the risk. Early walking and, where indicated, prophylaxis reduce it.
答案
B · Caesarean birth
2.产科护理
答案: B · Withhold the next dose and report the findings
为什么是这个答案
Terbutaline can cause maternal tachycardia, palpitations, chest pain, pulmonary oedema and hyperglycaemia, so it is used only short term. A maternal heart rate above about 120/min or chest pain means the drug should be held and the provider informed.
答案
B · Withhold the next dose and report the findings
3.剂量计算
答案: D = 450 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。
剂量
5·90 = 450 mg
答案
D = 450 mg
4.剂量计算
答案: D = 297.3 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).
体表面积
BSA = √(134·38/3600) = √1.414 = 1.189 m²
剂量
D = 250·1.189 = 297.3 mg
答案
D = 297.3 mg
5.静脉输液速度
答案: V = 360 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）
30·60/60 = 30 mL/h
体积
V = 30·12 = 360 mL
答案
V = 360 mL
6.静脉输液速度
答案: Δ = 20 %
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
500/12 = 41.67 mL/h
新速率
R = 150/3 = 50 mL/h
变化百分比
Δ = (50 − 41.67)/41.67·100% = 20%
答案
Δ = 20%
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。
ExamProblems · examproblems.com/courses/maternity-nursing